摘要
目的通过组态分析探讨影响冠心病共病患者治疗负担的驱动因素,为改善冠心病共病患者治疗负担提供科学参考。方法采用横断面研究设计,于2022年8月至2023年2月便利抽样法选取在昆山市第一人民医院心血管内科住院的冠心病共病患者作为调查对象,使用一般资料调查表、中文版慢性病共存治疗负担问卷、心脏健康自我效能和自我管理量表、社会支持量表、慢性病患者医疗依从性量表进行调查。运用模糊集定性比较分析(fsQCA)从组态视角探究影响因素对冠心病共病患者治疗负担的协同影响机制,明确治疗负担的多重组态路径。结果最终纳入505例冠心病共病患者,其中男359例,女146例,年龄为(62.82±13.87)岁,其治疗负担的总分为(25.77±17.61)分,自我效能感、自我管理、社会支持及医疗依从性得分依次为(35.77±5.07)、(30.50±5.02)、(39.40±7.44)、(129.02±10.84)分。88.32%(446/505)患者所承受的治疗负担均达到了中高度水平;通过fsQCA揭示了5种高治疗负担和2种低治疗负担组态路径,其条件组合总覆盖度分别为0.426和0.384,总体一致性分别为0.877和0.900,在低治疗负担组态中,冠心病病程是构成低治疗负担的必要条件,而高治疗负担组态中,不存在单一因素可作为必要条件。结论通过解析各变量之间的相互作用与驱动效应,提出改善冠心病共病患者高治疗负担的靶向干预策略,以期为未来的医疗服务提供新的视角。
Objective To investigate the drivers of treatment burden among patients with coronary heart disease and multimorbidity using a configurational approach,and to provide scientific evidence for reducing treatment burden in this population.Methods A cross-sectional study was conducted from August 2022 to February 2023.Convenience sampling was used to recruit hospitalized patients with coronary heart disease and multimorbidity from the Department of Cardiology of the First People's Hospital of Kunshan.Data were collected using a general information questionnaire,the Chinese version of the Multimorbidity Treatment Burden Questionnaire,the Heart Health Self-Efficacy and Self-Management,the Social Support Rating Scale,the Medical Adherence Scale for Chronic Patients.Fuzzy-set qualitative comparative analysis(fsQCA)was employed to explore the synergistic effects of influencing factors on treatment burden from a configurational perspective and to identify multiple configural pathways leading to varying levels of treatment burden.Results A total of 505 patients with coronary heart disease and multimorbidity were included,comprising 359 males and 146 females,with a mean age of(62.82±13.87)years.The total treatment burden score was(25.77±17.61).Scores for self-efficacy,self-management,social support,and medication adherence were(35.77±5.07),(30.50±5.02),(39.40±7.44),and(129.02±10.84),respectively.Notably,88.32%(446/505)of the patients experienced moderate-to-high treatment burden.Through fsQCA,five configurational paths associated with high treatment burden and two configurational paths associated with low treatment burden were identified.The overall coverage values for these configurations were 0.426 and 0.384,respectively,with overall consistency values of 0.877 and 0.900.The course of coronary heart disease was identified as a necessary condition for low treatment burden,while no single factor alone was necessary for high treatment burden.Conclusions By elucidating the interactions and driving effects among multiple variables,this study proposes targeted intervention strategies to alleviate high treatment burden in patients withcoronary heart disease and multimorbidity,offering new insights for future healthcare delivery.
作者
张美美
李爱仙
周娟娟
王田燕
张倩倩
常绪田
王逸雯
朱月兰
Zhang Meimei;Li Aixian;Zhou Juanjuan;Wang Tianyan;Zhang Qianqian;Chang Xutian;Wang Yiwen;Zhu Yuelan(Department of Cardiovascular Medicine,the First People's Hospital of Kunshan,Kunshan 215300,China;Department of Nursing,the First People's Hospital of Kunshan,Kunshan 215300,China;Kunshan Women and Children's Healthcare Hospital,Kunshan 215300,China;Jiangsu University School of Medicine,Zhenjiang 212013,China;Department of Emergency Medicine,the First People's Hospital of Kunshan,Kunshan 215300,China;Department of Nephrology,the First People's Hospital of Kunshan,Kunshan 215300,China)
出处
《中国实用护理杂志》
2025年第36期2830-2839,共10页
Chinese Journal of Practical Nursing
关键词
冠心病共病
治疗负担
影响因素分析
模糊集定性比较分析
组态路径
Coronary heart disease and multimorbidity
Treatment burden
Analysis of influencing factors
Fuzzy set qualitative comparative analysis
Configurational paths
