基于德尔菲法的慢病患者满意度调查问卷编制及信效度检验△

目的：设计科学、实用及有效的慢性病患者满意度调查问卷，为分析影响慢病患者满意度的因素提供可靠的评估工具。方法：通过查阅文献、访谈及组内讨论等方式，制定初步的调查问卷，选择专业领域专家进行2轮德尔菲法咨询。结果：针对2轮德尔菲咨询结果进行分析，根据分析结果对各项条目进行调整修改，并通过预调查对问卷中的量表信息进行信效度检验，以验证问卷的科学性。结论：慢性病患者满意度问卷具有良好的信效度，对于分析慢性病患者满意度影响因素具有一定的参考价值。     

188名老年慢性心衰患者健康赋权现况及影响因素分析

目的 了解老年慢性心衰患者健康赋权现况,并分析其健康赋权的影响因素。 方法 选取188例老年慢性心衰患者作为研究对象,使用一般资料调查问卷、老年慢性疾病患者健康赋权量表和全面健康素养测量量表对患者进行调查,使用分层回归分析对患者健康赋权的影响因素进行分析。 结果 老年慢性心衰患者健康赋权得分为(84.42±24.18)分,以获取支持维度均分(3.68±1.13)最高,参与治疗维度均分(2.81±0.97)最低;健康素养得分为(19.86±5.35)分,以与健康照护者的沟通能力维度均分(2.18±0.64)最高。分层回归分析显示年龄、文化程度、病程及合并症是患者健康赋权的影响因素,可解释健康赋权变异的24.7%;此外,使用书面健康信息的能力及健康信息的评价和应用能力可单独解释健康赋权变异的10.3%。 结论 老年慢性心衰患者的健康赋权受多重因素影响,医疗工作者应综合多方因素为患者提供最佳赋权教育,以提高其健康赋权水平。     

慢性病患者症状管理自我效能的研究进展

慢性病病因复杂,病程长,患者往往出现多种症状,这些症状反复出现会增加并发症和死亡的风险,因此提高慢性病患者对症状的自我管理能力,对提高生活质量,改善预后有积极作用。症状管理的自我效能指患者对管理自身症状能力的信心,这种信心越强,患者越能够积极主动参与到疾病的治疗与护理当中,对健康结局有积极的影响。本文综述慢性病患者症状管理自我效能的定义、测评工具、相关因素及干预性研究进展,以期为国内慢性病患者症状管理自我效能的干预研究提供依据。     

慢性病患者电子健康素养研究进展

互联网的快速发展使各类医疗服务向数字化转变,慢性病管理也不例外,在线健康信息和移动健康应用程序等电子健康服务逐渐融入慢性病管理中。与此同时,慢性病患者被要求具备相应的技能以适应慢性病管理的数字化转变,这样的技能被称之为电子健康素养或数字健康素养。本文阐述了电子健康素养的内涵,总结了慢性病患者电子健康素养的测量工具及方式,同时还从慢性病患者角度分析了电子健康素养的影响因素以及电子健康素养与健康结局之间的关系,以期为慢性病患者电子健康素养研究提供参考。     

家庭医生在慢性病管理中作用的研究进展

加强家庭医生服务能力建设,更好的推进和完善家庭医生签约服务是目前我国的重要举措。以慢性病管理为突破口,可以为优化相关政策提供更科学的依据。本文针对家庭医生在慢性疾病患者中的发展历程、影响因素、在慢病管理中的应用等方面进行综述,以期能有效地改进相关影响因素,更好的推广家庭医生,提高慢性病患者的管理水平。     

老年慢性病患者生命质量现状及影响因素研究

目的：了解我国老年慢性病患者的生命质量状况,探究其影响因素,为制定相关政策提供依据。方法：采用多阶段抽样方法,针对120个城市的居民进行横断面研究;应用量表进行问卷调查,探究老年慢性病患者抑郁、自我效能、疾病感知与生命质量的相关性;运用多元线性回归方法分析老年慢性病患者生命质量的影响因素。结果：老年慢性病患者生命质量得分为22.90±2.81分,已婚、周围有基层医疗卫生机构的老年慢性病患者生命质量较高,疾病感知与抑郁对老年慢性病患者生命质量产生显著负向影响,自我效能对老年慢性病患者生命质量产生显著正向影响。结论：我国老年慢性病患者生命质量偏低,应加强居家照护,提升基层医疗卫生服务能力,开展健康教育,综合提升老年人的健康素养。     

老年慢性病患者生活质量评价

目的 探讨老年慢性病患者的生活质量状况及其影响因素，为老年人群慢性病的防治和生活质量的改善提供依据。方法 从重庆市部分医院收集2001例老年慢性病患者的临床资料，采用国际通用的“脉搏”量表(PULSES)对他们的日常生活能力进行评分。结果 患者生活质量和所患疾病数量有关，患病数量越多，生活质量越差；恶性肿瘤患者和脑血管疾病患者总体生活质量最差；不同种类的疾病对患者各单项功能的影响轻重不同。结论 老年人群慢性病患者的生活质量主要受所患疾病的种类及数量影响，应采取干预措施减少各种并发症的发生，以改善患者生活质量。     

健康赋权在养老机构老年人创伤后成长和慢性病自我管理的中介作用

目的 了解养老机构老年人慢性病自我管理现状,探讨健康赋权在养老机构老年人创伤后成长和慢性病自我管理的中介作用。方法 采用随机数字表法和整群抽样法,应用一般资料调查表、慢性病自我管理量表、创伤后成长量表、老年人健康赋权量表对203名养老机构老年人进行问卷调查。采用独立样本t检验、单因素方差分析和Pearson相关分析对养老机构老年人健康赋权、创伤后成长和慢性病自我管理的影响因素进行分析,应用Bootstrap法检验健康赋权在创伤后成长与慢性病自我管理之间的中介作用。结果 老年人慢性病自我管理总分为（27.96±9.24）分,与创伤后成长和健康赋权均呈正相关（r = 0.547、0.540,P＜0.001）。创伤后成长（t = 6.117,P＜0.001）、健康赋权（t = 5.321,P＜0.001）、每天用药次数（t = 2.420,P = 0.016）是自我管理的独立影响因素,可解释总变异的40.4%。健康赋权在创伤后成长与自我管理之间存在部分中介作用,占总效应的28.32%。结论 养老机构老年人慢性病自我管理处于中等偏下水平,机构管理者和照顾者应重视健康赋权对自我管理的中介效应,提升老年人慢性病自我管理水平。     

慢性病患者疾病接受度的研究进展

对慢性病患者的疾病接受度进行研究可以促进患者更好的适应疾病过程,从而提高慢性病患者的身心健康。本文对慢性病患者疾病接受度的概念、测评工具以及影响因素进行综述,旨在为相关研究提供依据。     

我国老年人慢性非传染性疾病防控研究进展

随着我国老龄化形势不断加剧,老年人口成为罹患慢性病的主要人群,在身体机能逐渐下降的情况下,慢性病还会加剧其生活负担,影响生活质量,探索一套防控老年人慢性病的工作模式,是整体防控管理的重要一环。本次研究主要通过对国内外相关文献进行综合分析,系统介绍了我国老年人慢性病患病、疾病负担、危险因素流行情况,总结了当前我国针对老年人慢性病所开展的防控工作。     

Patient empowerment,an additional characteristic of the European definitions of general practice/family medicine

Abstract

Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals’ satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: ‘promote patient empowerment’. The aim of this paper is to clarify the meaning of 'patient empowerment’ and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.     

Sudden illness and biographical flow in narratives of stroke recovery

The conceptual framework of biographical disruption has dominated studies into the everyday experience of chronic illness. Biographical disruption assumes that the illness presents the person with an intense crisis, regardless of other mitigating factors. However, our data suggests that the lives of people who have a particular illness that is notably marked by sudden onset are not inevitably disrupted. Extensive qualitative interviews were conducted with a sample of veteran non-Hispanic white, African-American, and Puerto Rican Hispanic stroke survivors, at one month, six months and twelve months after being discharged home from hospital. Narrative excerpts are presented to describe specific discursive resources these people use that offset the disrupting connotations of stroke. Our findings suggest a biographical flow more than a biographical disruption to specific chronic illnesses once certain social indicators such as age, other health concerns and previous knowledge of the illness experience, are taken into account. This difference in biographical construction of the lived self has been largely ignored in the literature. Treating all survivor experiences as universal glosses over some important aspects of the survival experience, resulting in poorly designed interventions, and in turn, low outcomes for particular people.     

反复住院2型糖尿病患者健康素养现状及影响因素分析

目的 通过调查分析反复住院2型糖尿病患者的健康素养现状及影响因素,为糖尿病的防治提供参考。方法 采用便利抽样法,于2020年6-10月对某市3所313例住院糖尿病患者采用一般资料调查表、慢性病病人健康素养量表、糖尿病授权简化量表、糖尿病自我管理简化量表进行问卷调查。一般资料采用t检验和方差分析,影响因素分析采用多元线性回归。结果 糖尿病患者的健康素养得分为（93.91±9.08）分,健康素养的具备率为31.95%。结果显示,文化程度（β=0.258, t=3.652, P<0.001）、授权（β=0.233,t=4.547,P<0.001）、户籍（β=0.211, t=3.167, P=0.002）、住院次数（β=-0.167, t=-2.813,P=0.005）、年龄（β=-0.336, t=-6.571, P<0.001）、经济负担（β=-0.175,t=-2.651, P=0.008）以及自我管理能力（β=0.153,t=2.936, P=0.004）对反复住院患者的健康素养产生影响。结论 反复住院的2型糖尿病患者的健康素养低下,卫生保健人员需要根据患者的不同情况制定个体化干预,大力开展糖尿病专科教育和科普活动,提高T2DM患者的健康素养,降低住院率。     

Understanding chronic malnutrition in childhood and old age: role of energy balance research

Undernutrition is commonly associated with chronic disease in children and the elderly. Overnutrition is also, but less commonly, associated with chronic illness. In most diseases malnutrition arises because energy intake does not match energy output. Traditionally, the focus of research has been on abnormalities in energy expenditure, in the belief that these factors were the main determinants of energy imbalance. Recent studies using the doubly-labelled-water method to measure total energy expenditure, combined with more complex study design, have suggested an alternative conclusion. In many chronic diseases patient behaviour, and particularly energy intake, is responsible for energy imbalance and malnutrition. Energy balance studies have therefore provided a useful foundation for the design of strategies aimed at preventing or managing chronic malnutrition. However, modifying patient behaviour is an ambitious undertaking which may not be within the scope of existing clinical nutrition services. A number of non-traditional models of managing chronic malnutrition in children and the elderly are promising. Increasing recognition of the value of systematic review will also provide improved strategies for prevention and management of chronic malnutrition.     

慢性病患儿糖皮质激素用药依从性及其影响因素的研究现状

糖皮质激素仍是目前儿童慢性疾病治疗与控制的首要选择，由于慢性病患儿与家长的共同参与以及患儿自身的特殊性，导致其用药依从的难度较大。既往研究没有对慢性病患儿糖皮质激素用药依从性的现状进行综述报道，该文将通过文献回顾对慢性病患儿糖皮质激素用药依从性及其影响因素的现状进行全面综述。     

The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review

The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic bio-psycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of well-designed intervention studies, and low numbers of included patients limited our conclusions.     

Education in sexuality for nurses

While the significant impact of disability and chronic illness on sexual functioning has been identified, education in sexuality for nursing staff is difficult to find in the literature. Given that many nursing professionals may not have received sufficient education in sexuality from formal curricula, the need for continuing education formats in sexuality is especially salient. This paper discusses the rationale for such programs, and presents a general format that has been carried out as a one- to two-day continuing education workshop.     

Empower Me? Yes,Please, But in My Way: Different Patterns of Experiencing Empowerment in Patients with Chronic Conditions

Empowerment is a widely used word within the realm of health care. This is especially true in the case of patients living with a chronic illness, who may be active participants and learn to manage their disease, irrespective of their desires or preferences. This article focuses on the empowering experience of patients with chronic conditions. We have built on earlier research that explains the factors that mediate communication between health care professionals and patients: patient participation, patient impact, meaning, health care professionals’ information provision, health care professionals’ emotional support, health care professionals’ attentive listening, health care professionals’ trust, and patient collaboration. We propose a new model for detecting types of patients who differ in the way they live their empowering experience. Using survey data from a sample of 181 patients of hemophilia, we found two types of patients: patients with an inner locus of empowerment and patients with an outer locus of empowerment. We conclude by discussing different strategies for fostering the sense of power in each of these types of patients.