沈阳市长白社区慢性病共病患病情况及老年患者积极度与健康结局的相关性研究

周玉刚; 王爽; 张陆; 肖焕; 赫曙光; 刘雪君; 于凯; 赵心; 于晓松

摘要

Objective To investigate the prevalence rates for chronic diseases and multiple chronic conditions (MCCs) among adults signing service contracts with general practitioners (GPs) and to study the correlation between patient activation and health outcomes among the elders in Changbai community,Shenyang.Methods Of the 35 268 residents in the community,we selected 4 569 adult residents including 1 979 aged 60 or over (the above numbers were counted as of March 2015) who had signed the service contracts with GPs.The baseline characteristics of them,including types and number of chronic diseases and basic health information (gender,age,educational attainment) were investigated with the uniform questionnaire from contracted residents' health records in March 2015.Meanwhile,we also selected 180 MCCs patients aged 60 ～80 from the adult residents,who visited Changbai Community Health Service Center from October 9,2014 to April 9,2015 and voluntarily participated in the questionnaire survey with Patient Activation Measure (PAM),Self-rated General Health,Condensed Memorial Symptom Assessment Scale (CMSAS) and Short Form 36 Questionnaire (SF-36).Results The prevalence rate of chronic diseases was respectively 49.64％ in all adults (2 268/4 569) and 73.17％ in the elders (1 448/1 979) in this community.The prevalence rate of MCCs was respectively 22.11％ (1 010/4 569) and 40.02％ (792/1 979).The prevalence rate for chronic diseases,MCCs among the 1 855 residents aged 60 ～80 was 73.21％ (1 358/1 855),and 40.32％ (748/1 855),respectively.No significant gender difference in the prevalence rate for chronic diseases existed between all the 4 569 adult residents (P ＞ 0.05).Remarkable age and educational attainment differences were observed in the prevalence rate for chronic diseases between the 4 569 adult residents (P ＜ 0.05).There were distinct gender,age and educational attainment differences in the prevalence rate for MCCs between the 4 569 adult residents (P ＜0.05).In the 180 MCCs patients aged 60 ～ 80,the mean patient activation scores were (58.3 ± 10.8),the proportion of patients with grade 1,2,3,4patient activation was 13.33％ (24/180),26.11％ (47/180),43.89％ (79/180) and 16.67％ (30/180),respectively;MCCs patients with symptoms of depression or anxiety had lower patient activation scores than those without depression or anxiety did (P ＜ 0.05).Spearman rank correlation analysis found that patient activation scores were positively associated with self-rated general health (rs =0.268,P ＜ 0.05).Results of Pearson correlation analysis demonstrated that patient activation scores were linear correlated positively with total seores of self-rated quality of life,physical health,and mental health (P ＜0.05);and they were well linear correlated with the dimension scores of role-physical,general health,vitality,and emotional health (P ＜ 0.05).Conclusion In Changbai community,Shenyang,a large proportion of adults signing service contracts with GPs have chronic disease anl MCCs,and patient activation is correlated positively with health outcomes.All these indicate that the management of MCCs and integrated control of multiple cardiovascular risk factors are urgent and important,and the coexistence of chronic diseases and mental health problems should be particularly concerned about.And improving the patient activation is suggested to be a new management strategy in primary care in order to cope with the growing burden of chronic diseases.%目的了解沈阳市长白社区全科医生签约成年居民慢性病及其共病(MCCs)患病情况,探讨老年MCCs患者积极度与健康结局的相关性.方法截止到2015年3月,沈阳市长白社区卫生服务中心辖区常住居民35 268例,已与全科医生团队建立签约服务关系的签约成年居民4 569例,其中60岁及以上的老年居民1 979例.依据自愿参加原则,选取于2014-10-09至2015-04-09到长白社区卫生服务中心就诊的60 ～80岁签约MCCs患者180例.于2015年3月,采用统一制定的调查表从签约成年居民个人健康档案中提取性别、年龄、受教育程度、慢性病患病情况等相关信息.采用患者积极度量表(PAM)、健康状况自评问卷、简明记忆症状评估量表(CMSAS)、健康调查量表(SF-36)等对180例60 ～ 80岁签约MCCs患者进行问卷调查.结果 4 569例签约成年居民中,慢性病患者2 268例,MCCs患者1 010例,慢性病、MCCs患病率分别为49.64％、22.11％.1 979例签约老年居民中,慢性病患者1 448例,MCCs患者792例,慢性病、MCCs患病率分别为73.17％、40.02％.1 855例60 ～80岁签约居民中,慢性病患者1358例,MCCs患者748例,慢性病、MCCs患病率分别为73.21％、40.32％.不同性别的签约成年居民慢性病患病率比较,差异无统计学意义(P＞0.05);不同年龄、受教育程度的签约成年居民慢性病患病率比较,差异均有统计学意义(P＜0.05).不同性别、年龄、受教育程度的签约成年居民MCCs患病率比较,差异均有统计学意义(P＜0.05).180例60 ～ 80岁MCCs患者积极度平均得分为(58.3±10.8)分;患者积极度第1、2、3、4水平患者数分别为24例(13.33％)、47例(26.11％)、79例(43.89％)、30例(16.67％);抑郁/焦虑阳性患者积极度总分与阴性患者比较,差异有统计学意义(P＜0.05).Spearman秩相关分析结果显示,患者积极度得分与自评健康状况呈正相关(rs =0.268,P＜0.05).Pearson相关分析结果显示,患者积极度得分与生活质量总分、生理健康总分、心理健康总分均呈直线正相关(P＜0.05),与生理职能、总体健康、活力、精神健康维度得分均呈直线正相关(P＜0.05).结论沈阳市长白社区全科医生签约成年居民的慢性病、MCCs患病率较高,患者积极度水平与健康结局呈正相关.提示应重视基层MCCs患者管理和多重心血管疾病危险因素的综合控制,尤其关注躯体疾病和心理健康问题并存的情况,并建议将提高患者积极度作为一项新的基层管理策略,以应对日益增长的慢性病负担.

沈阳市长白社区慢性病共病患病情况及老年患者积极度与健康结局的相关性研究

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