摘要
目的评价“疾病预防控制中心-综合医院-社区卫生服务中心”综合管理模式对社区慢性阻塞性肺疾病(慢阻肺病)患者的干预效果。方法本研究为整群随机对照研究。于2022年1月至3月在湖北省赤壁市4个社区招募236例慢阻肺病患者,实际完成随访并参与干预评估者共223例。采用整群随机分组将研究对象分为干预组(121例)和对照组(102例)。干预组采取为期一年的“三位一体”社区综合管理模式,对照组进行基本随访。干预前后均采取面对面问卷调查,收集两组研究对象的基本情况、知晓情况、危险因素、呼吸道症状、用药和疾病管理等信息,并进行生活质量评分和肺功能检查,对干预前后相关指标进行比较和评价。结果干预后,干预组慢阻肺病疾病名称知晓率和相关知识知晓率均高于对照组(94.12%比77.78%和78.15%比49.49%,均P<0.05);干预组吸烟率和现在吸烟率均低于对照组(57.14%比70.71%和29.41%比47.47%,均P<0.05);干预组家庭取暖污染燃料使用率低于干预前(17.65%比28.93%,P<0.05),对照组前后无明显变化;干预组吸入式药物使用率高于对照组(14.05%比2.94%),且运动训练率和呼吸肌训练率均高于对照组(22.31%比2.94%和26.45%比0.98%)(均P<0.05);干预组出现慢性咳痰、喘息、气短或呼吸困难症状的发生率均低于对照组(12.40%、0.83%、27.27%比24.51%、9.80%、41.18%,均P<0.05);肺功能指标方面,干预组第1秒用力呼气容积占预计值百分比高于对照组[(69.53±18.01)%比(54.90±12.39)%,P<0.05]。结论“三位一体”综合管理模式有助于提高慢阻肺病患者的健康素养和自我管理能力,改善危险行为因素,并提高患者生活质量,符合慢阻肺病长期化、个性化的管理需求。
ObjectiveTo evaluate the effectiveness of an integrated management model involving the Centers for Disease Control and Prevention(CDC),general hospitals,and community health service centers in improving outcomes for community-dwelling patients with chronic obstructive pulmonary disease(COPD),with the aim of optimizing existing COPD management strategies.MethodsThis study was a cluster randomized controlled trial.From January to March 2022,a total of 236 patients with COPD were recruited from four communities in Chibi City,Hubei Province.Ultimately,223 patients completed follow-up and participated in the intervention evaluation.The participants were cluster-randomized into an intervention group(n=121)and a control group(n=102).The intervention group received a one-year"trinity"integrated community management model,while the control group received only basic follow-up.Face-to-face questionnaires were administered before and after the intervention to collect data on demographics,disease awareness,risk factors,respiratory symptoms,medication use,and disease management.Quality of life scores and pulmonary function tests were also assessed.Pre-and post-intervention outcomes were compared using t-tests or chi-square tests.ResultsThe intervention group demonstrated significantly higher rates of COPD awareness and disease-related knowledge compared to the control group(94.12%vs 77.78%and 78.15%vs 49.49%;both P<0.05),along with lower overall smoking rate and current smoking rate(57.14%vs 70.71%and 29.41%vs 47.47%;both P<0.05).The intervention group showed reduced household polluting fuel use for heating(17.65%vs 28.93%;P<0.05),while the control group exhibited no significant change.Significant improvements were observed in the intervention group for inhaler medication usage(14.05%vs 2.94%),exercise training,and respiratory muscle training(22.31%vs 2.94%and 26.45%vs 0.98%)(all P<0.05).Additionally,the intervention group reported lower prevalence of chronic sputum production,wheezing,and dyspnea(12.40%,0.83%,27.27%vs 24.51%,9.80%,41.18%;all P<0.05)compared to controls.Pulmonary function tests revealed that the percentage of forced expiratory volume in one second(FEV 1%predicted)was significantly higher in the intervention group than in the control group[(69.53±18.01)%vs(54.90±12.39)%;both P<0.05].ConclusionsThe"trinity"integrated management model effectively enhances health literacy,self-management capabilities,and quality of life among COPD patients,while reducing behavioral risk factors.This model aligns with the long-term and individualized management needs of COPD patients.
作者
唐雨萌
张岚
方利文
赵安平
邵燕红
但丽琼
祝淑珍
Tang Yumeng;Zhang Lan;Fang Liwen;Zhao Anping;Shao Yanhong;Dan Liqiong;Zhu Shuzhen(Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China;National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Chibi Center for Disease Control and Prevention,Xianning 437300,China)
出处
《中华健康管理学杂志》
北大核心
2025年第11期869-875,共7页
Chinese Journal of Health Management
基金
国家科技重大专项(2023ZD0509900)
中国中医药科技发展中心中西医协同慢病管理研究项目(CXZH2024155)。
关键词
肺疾病
慢性阻塞性
社区卫生中心
疾病预防控制中心
综合医院
综合管理模式
干预性研究
Pulmonary disease,chronic obstructive
Community Health Centers
Centers for Disease Control and Prevention
General hospital
Integrated management mode
Intervention research
