上海浦东慢性病自我管理项目实施效果评价研究

目的：评上海浦东区慢性病自我管理项目实施6个月之后的效果。方法：按照以社区为基础的随机的机对照试验研究设计，将297名 高血压病，心脏病，关节炎，中风， 哮喘，糖尿病，COPD等疾病自愿参加该项目的慢性病人，随机分为干预组和对照组。采用协方差的秩检验，比较了在基线及项目实施6个月之后两次问卷调查的140名干预组病人和129名对照组病人在自我管理行为，自我效有，健康状况和卫生服务利用等方面的变化。结果：与对照组合组比较，干预组在一种自我管理和为方面明显提高，6个月内认知性症状管理方法实践评分，干预组平均多增加了0．11分，症状管理自我效能和疾病共性管理自我效能评分6个月的增加值，分别经对照组高出1．08分和1．07分，干预组在健康状况的8个方面（整合健康自评，健康担忧，疲劳、气短、疼痛，疾病对病人生活影响，情绪低落及社会活动／角色受限），明显好于对照组（P值均＜0．05），干预组6个月内住院次数平均比对照组减少了0．14次（P＝0．01）；住院天数比对照组平均下降了0．87天（P＜0．01）。结论：上海浦东新区慢性病自我管理项目实施6个月之后改善参加者的自我管理行为，自我效能，部分健康状况，减少住院次数和住院天数。     

上海慢性病自我管理项目对自我效能的影响评价

目的　评价上海慢性病自我管理健康教育项目实施 6个月之后在改变患者自我效能方面的效果。方法　按照社区随机对照试验研究设计 ,将 954名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD)等疾病自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩检验 ,比较了有基线和 6个月之后两次问卷调查数据的 4 30名干预组患者和 34 9名对照组患者在项目实施 6个月之后在自我效能评分方面的变化。结果　干预组患者的症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 0 6 9分和 0 6 3分 (P值均 <0 0 1)。结论　上海慢性病自我管理项目可提高参加者对疾病管理的自我效能     

某社区慢性病自我管理健康教育对自我效能的影响

[目的 ]　评价社区慢性病自我管理健康教育项目对改变患者自我效能的效果。　 [方法 ]　按照社区随机对照试验研究设计 ,将 2 97名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD )等疾病并自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩检验 ,比较有基线和 6个月后两次问卷调查数据的 12 8名干预组病人和 12 7名对照组病人于项目实施 6个月之后在自我效能方面的变化。　 [结果 ]　干预组病人的症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 1.0 8分和 1.0 7分 (P值均 <0 .0 1)。　 [结论 ]　慢性病自我管理项目实施 6个月后改善了参加者对疾病管理的自我效能     

上海市某社区高血压群组干预管理效果评价

[目的]评价上海市某社区高血压群组干预管理模式实施6个月后的效果。[方法]按照随机对照试验研究设计,将369名参加该研究的高血压病人随机分为185名干预组和184名对照组。干预组接受高血压群组干预管理模式,对照组接受常规的高血压三级管理模式。然后比较两组病人在项目实施前和实施6个月后在生活方式相关行为、自我管理行为、自我效能、健康状况、卫生服务利用情况和血压控制方面的变化。[结果]干预组6个月后在生活方式相关行为改变方面明显提高(P<0.05),并明显高于干预后的对照组(P<0.05)。在部分自我管理行为(服药依从性、医患交流)、部分自我效能(症状管理自我效能)、健康状况4个方面的变化值(精力、健康担忧、健康自评、情绪低落),明显好于对照组(P均<0.05)。6个月内看门诊次数平均比对照组少0.74次(P<0.05);6个月内住院次数平均比对照组减少了0.07次(P<0.05);6个月后干预组病人平均比对照组多降低收缩压4.06 mmHg,多降低舒张压2.16 mmHg(P均<0.05)[结论]社区高血压群组干预管理模式较传统的高血压三级管理模式在改善生活方式相关行为、改善自我管理行为、自我效能、健康状况、减少卫生服务利用、降低血压等方面效果更好。     

社区实施慢性病自我管理项目的研究

[目的]在社区实施慢性病自我管理项目，并评估其对慢性病患者综合干预效果，进而在多个社区进行推广。[方法]在徐汇区长桥社区，开展慢性病自我管理项目社区动员6个月，对636名志愿参加慢性病自我管理项目的居民，随机分为干预组326人，对照组278人，采用统一问卷进行基线调查后，对干预组实施慢性病自我管理项目综合干预，对照组不做干预，6个月后再次进行问卷调查。[结果]干预组每周平均耐力锻炼时间增加，明显高于对照组（F=6．09，P：0．01），认知症状管理方法实践评分亦高于对照组，两者差异有统计学意义（F=121．95，P=0．00）；干预组在健康状况的6个方面（整体健康自评、健康担忧、气短、疼痛、失能、情绪低落）明显好于对照组，两组之间差异有统计学意义（P〈0．05）。[结论]在社区开展慢性病自我管理项目综合干预,取得了良好效果。     

深圳市社区高血压自我管理小组效果分析

目的评价深圳市社区高血压自我管理小组项目实施6个月后在改变患者行为、健康状况、生活质量和自我效能方面的效果。方法将社区自愿报名参加该项目的高血压患者随机分为干预组（n=120）和对照组（n=110）。干预组接受高血压自我管理小组课程管理,对照组不接受管理,项目实施6个月。干预前后进行问卷调查,对两组患者的高血压防治知识的知晓情况、高血压相关行为危险因素、血压控制和自我效能进行比较。结果干预后,干预组高血压防治相关知识知晓率、控制体重率（51．7％）、规律服药率（80．8％）、高血压控制率（90．0％）及自我管理效能得分均高于干预前和对照组干预后,差异均有统计学意义（P〈0．05）。结论社区高血压自我管理小组模式在改善高血压患者生活方式相关行为、自我管理行为、自我效能、降低血压、提高高血压控制率方面效果良好。     

武进区慢性病自我管理项目实施效果评价

目的评价武进区慢性病自我管理项目实施1年后的效果。方法将919名患有高血压和(或)糖尿病的患者按随机对照试验研究设计,随机分成干预组和对照组,比较两组在干预前后的自我效能、自我管理行为和卫生服务利用等方面的变化。结果 1年后干预组和对照组相比,平均收缩压多下降6.69 mm Hg,舒张压多下降1.89 mm Hg,空腹血糖多下降0.29mmol/L,体质指数多下降0.27kg/m2,差异均有统计学意义(P0.05);自我效能评估,症状管理自我效能多增加0.29分,疾病共性管理自我效能多增加0.74分,差异均有统计学意义(P0.05);自我管理行为,有氧锻炼多增加22.28min/周,认知症状管理多增加0.22分,与医生沟通情况多增加0.23分,差异均有统计学意义(P0.05);卫生服务利用情况,干预组在近6个月内看门诊次数、急诊次数、住院次数和住院天数分别下降1.31次、0.03次、0.05次和0.48天,但差异未见统计学意义。结论开展慢性病自我管理项目能提高患者自我效能,改善自我管理行为,降低血压、血糖水平。     

护理干预对腹膜透析病自我管理行为的影响

目的：探讨护理干预对腹膜透析病人的自我管理行为的影响。方法：以方便抽样方法将研究对象分为实验组和对照组各24例，实验组病人接受护理干预，对照组接受常规健康教育，采用自行设计的自我管理问卷和简明健康调查问卷（SF-36）于干预前、干预后6个月调查病人的自我管理行为和健康相关生活质量（HRQOL）。结果：干预后两组病人自我管理行为、HRQOL比较有统计学意义（P〈0．05或P〈0．01）。结论：护理干预可以改善病人的自我管理行为，提高其HRQOL。     

社区高血压患者自我管理对自我效能及其血压相关行为危险因素的影响

目的评价自我管理在改变高血压患者自我效能及其血压相关行为危险因素等方面的效果,为高血压的干预提供依据。方法采用实验流行病学中的社区试验方法,将社区中自愿参加自我管理小组的高血压患者以社区为单位随机分为干预组（1410例）和对照组（665例）。干预组采用自我管理,对照组采用高血压规范化管理。干预组和对照组均接受基线和6周之后的2次问卷调查,并对干预组和对照组活动前后的数据进行比较。结果经过6周活动,干预组每日吸烟率与饮酒率分别下降了16．9％和17．9％,而规律运动参与率与心理调节率则分别提高了18．3％和7．9％,差异均有统计学意义（P〈0．01）;对照组基本无变化。干预组干预后收缩压和血压控制率有明显改善,差异有统计学意义（P〈0．05）,干预组干预后比干预前症状管理自我效能和疾病共性管理自我效能评分的增加值分别比对照组高0．55分和3．24分;增加值与对照组比较,差异均有统计学意义（t值分别为172．209、166．075,P〈0．01）。结论社区高血压患者通过自我管理措施不仅可以提高其自我效能指标,而且有助于促进管理对象健康行为的形成。     

兰州市某社区慢性病患者依从行为 水平及影响因素调查研究

摘要：目的　分析兰州市某社区慢性病患者依从行为现状及影响因素，为提高患者的依从性水平，有针对 性地进行慢性病的个性化干预提供理论依据。方法　选取２０１６年３～９月在兰州市某社区卫生服务中心就 诊以及在兰州大学第一医院和兰州大学第二医院体检中心体检的慢性病患者６９０例，进行问卷调查，运用 描述性统计分析等方法对数据分析。结果　患者依从行为平均得分（４９．７４±７．４３） 分，标准化均分７５．３６ 分，居于中等偏上水平。多元线性回归分析结果显示，年龄３６～５９ 岁（β＝４．３７９，犘＝０．０２０）；≥６０ 岁 （β＝６．０５５，犘＝０．００１）；大专（β＝１．８１４，犘＝０．０１１）； 居住状况中和配偶一起（β＝２．２９４，犘＝０．００３）； 和子女一起（β＝２．３１６，犘＝０．００８）；住院经历（β＝０．８８７，犘＝０．０２９）；并发症（β＝０．８５９，犘＝０．０３９）； 支持利用度（β＝０．３１６，犘＝０．００１）和自我效能（β＝０．６７３，犘＝０．０００） 是患者依从行为的影响因素。结 论　在对慢性病进行干预时，可以利用同伴和家庭资源对患者进行教育和帮助，注重提升患者的支持利用 度和自我效能，加强对年轻群体慢性病患者的重视，提高患者的依从性。 关键词：慢性病；高血压；糖尿病；依从行为；影响因素 中图分类号：Ｒ１９３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１９）０２ ００９８ ０６     

Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai,China: randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.     

Effect Evaluation of a Self-Management Program for Dutch Workers with a Chronic Somatic Disease: A Randomized Controlled Trial

Purpose The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease. Methods In a randomized controlled trial, the effectiveness of a Self-Management Program was evaluated. Participants were randomly assigned to the experimental group (n = 57) and the control group (n = 47). The experimental group received an intervention, the control group received care as usual. Primary outcome measures were self-efficacy at work and the attitude towards self-management at work. Secondary outcomes were the SF-12 health survey questionnaire, job satisfaction and intention to change job. The results were measured at baseline, after the intervention and 8 months after the intervention. Results The attitude towards self-management at work (enjoyment) improved after 8 months for the intervention group (p = 0.030). No other outcome variable differed significantly. As an interaction effect, it was found that low educated workers developed a better physical health quality (SF-12) in the intervention group compared with the control group. The attitude towards self-management at work (importance) improved in the intervention group for older and female workers and the attitude toward enjoying self-management at work improved for female workers only. Conclusion The results show that low educated workers, older workers and women benefit significantly more from the training than higher educated workers, younger workers and men.     

Exploring the role of self-management programmes in caring for people from culturally and linguistically diverse backgrounds in Melbourne, Australia

BACKGROUND: Chronic disease self-management programmes are now an important adjunct to the treatment and care of Australians with chronic illnesses. Most programmes are delivered in English and cater for 'Anglo' views of health and illness. The Peer-Led Self-Management of Chronic Illness Project was funded by the National Health and Medical Research Council (NHMRC) to test the hypothesis that the Stanford University Chronic Disease Self-Management Program would improve health outcomes for people from the Vietnamese, Greek, Chinese and Italian communities in Melbourne's north-eastern suburbs. OBJECTIVE: To examine the extent to which the programme required modification so that the concepts associated with self-management programmes have relevance to the health behaviours of people with chronic illness from the above communities. METHODS: Four focus groups facilitated in English, using interpreters. RESULTS: There was wide understanding of the concepts employed in self-management programmes. Literacy problems emerged as the major obstacle to participating in unmodified programmes. CONCLUSION: The conceptual aspects of the programme require less modification than originally predicted, but the programme requires sensitive modification so that it is accessible to people with low literacy levels.     

A randomized controlled study of the Arthritis Self-Management Programme in the UK

The objective of this study was to determine whether the Arthritis Self-Management Programme (ASMP) improves perceptions of control, health behaviours and health status, and changes use of health care resources. The design was a pragmatic randomized controlled study; participants were allocated to ASMP (Intervention Group) or a 4-month waiting-list Control Group. The Intervention Group completed a 12-month follow-up. In total, 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group. Main outcome measures included: arthritis self-efficacy, health behaviours (exercise, cognitive symptom management, diet and relaxation) and health status (pain, fatigue, anxiety, depression and positive affect). At 4 months follow-up, the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales. Performance of a range of health behaviours (cognitive symptom management, communication with physicians, dietary habit, exercise and relaxation) was significantly greater among the Intervention Group. The Intervention Group were significantly less depressed and had greater positive mood. In addition, trends towards decreases on fatigue and anxiety were noted. Physical functioning, pain and GP visits remained stable at 4 months. A similar pattern of findings was found at 12 months follow-up for the Intervention Group. Furthermore, a significant improvement was found on pain and visits to GPs had decreased. Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months, all effects were independent of the type of arthritis. The findings suggest that the ASMP is effective in promoting improvements in perception of control, health behaviours and health status, when delivered in UK settings.     

The effect of the Vermont Diabetes Information System on inpatient and emergency room use: results from a randomized trial

OBJECTIVE: To describe the effect of the Vermont Diabetes Information System (VDIS) on hospital and emergency room use DATA SOURCE: Statewide discharge database STUDY DESIGN: Randomized controlled trial of a decision support system for 7,412 adults with diabetes and their 64 primary care providers. DATA COLLECTION/ DATA EXTRACTION: Charges and dates for hospital admissions and emergency room care in Vermont during an average of 32 months of observation. Data from New York hospitals were not available. PRINCIPAL FINDINGS: Patients randomized to VDIS were admitted to the hospital less often than control subjects (0.17 admissions vs. 0.20; P=0.01) and generated lower hospital charges ($3,113 vs. $3,480; P=0.019). VDIS patients also had lower emergency room utilization (0.27 visits vs. 0.36; P<0.0001) and charges ($304 vs. $414; P<0.0001). The intervention was particularly effective in men and in older subjects. CONCLUSIONS: In spite of data limitations that tended to reduce the apparent effect of the system; this randomized, controlled trial showed that VDIS reduces hospitalization and emergency room utilization and expenses.     

Provider networks and primary‐care signups: do they restrict the use of medical services?

This article analyzes the effect of gatekeeper and network restrictions on use of health‐care services using simulation‐based estimation methods. Data from the Community Tracking Survey (1996–1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office‐based visits to non‐physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary‐care provider have more visits to non‐physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out‐of‐network services have more office‐based and emergency room visits, but less surgeries and hospitalizations. Copyright © 2008 John Wiley & Sons, Ltd.     

A descriptive analysis of emergency visits to an inner city family practice center

A six-month prospective study of daily emergency visits was performed at an inner city family practice center in order to understand the utilization pattern of emergency services. 487 visits were identified during the study period. In general, patients of junior residents made more visits. The majority of visits (97%) were nonemergent. The most common presenting complaint was a general symptom (17%), although the most frequent diagnosis was in the supplementary category (17%) that includes medication renewals, the completion of forms and maternal and child health care. Females, the unemployed, the elderly, and individuals with poverty levels of income were most frequently seen in the emergency setting. The reasons for these patterns and the need for further investigations in this area are discussed.