综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

目的 探讨健康信念综合提醒系统对脑卒中患者出院后6个月健康知识、信念、行为、卫生服务利用情况及临床结局的效果。方法 2015年2月至2016年3月,方便抽样广州市3家综合医院高血压并发缺血性脑卒中出院患者174例,分为对照组(n = 87)和干预组(n = 87)。对照组予常规健康教育;干预组在此基础上采用“基于健康信念模式的综合提醒系统”进行健康教育和延续护理。出院6个月后,采用脑卒中健康知识问卷(SKQ)、脑卒中患者健康信念简表(SF-HBMS-SP)和脑卒中健康行为量表(HBS-SP)进行调查,并记录临床结局(急诊就诊、再住院、复发和死亡)。结果 对照组75例、干预组76例完成调查。干预组SKQ (U = 903.000)、SF-HBMS-SP (t = -9.099)和HBS-SP (t = -7.786)总分均显著高于对照组(P < 0.001)。干预组门诊复诊率(97.37%)显著高于对照组(76.00%) ( P <0.001);两组急诊就诊数和再住院数无显著性差异(P > 0.05),死亡和复发率无显著性差异( P > 0.05)。 结论 健康信念综合提醒系统能提高脑卒中患者出院后健康知识、信念、行为和门诊复诊率,但尚未对临床结局产生明显效果。

Effect of Comprehensive Reminder System on Health Knowledge,Belief and Behaviors,and Clinical Outcomes for Stroke Patients Six Months after Discharge

Objective To investigate the effect of Comprehensive Reminder System Based on Health Belief Model (CRS-HBM) on health knowledge, belief, behaviors, utilization of health services and clinical outcomes in stroke patients after discharge. Methods From February, 2015 to March, 2016, 174 stroke patients with hypertension were divided into control group (n = 87) and intervention group (n = 87). The control group received routine stroke health education, and the intervention group received the CRS-HBM program in addition. They were investigated with Stroke Knowledge Questionnaire (SKQ), Short Form Health Belief Model Scale for Stroke Patients (SF-HBMS-SP), Health Behavior Scale for Stroke Patients (HBS-SP), and the utilization of health services and clinical outcomes (emergency, re-hospitalization, recrudescence and death) were recorded six months after discharge.Results A total of 75 cases in the control group and 76 in the intervention group finished the research. The total scores of SKQ (U = 903.000), SF-HBMS-SP (t = -9.099) and HBS-SP (t = -7.786) were more in the intervention group than in the control group (P< 0.001). The outpatient re-visit rate was more in the intervention group (97.37%) than in the control group (76.00%) (P< 0.001). The incidence of emergency, re-hospitalization, recrudescence and death were not significantly different between the two groups (P > 0.05). Conclusion The application of CRS-HBM can improve the health knowledge, belief, behaviors for stroke patients after discharge, but there are not enough effects on clinical outcomes.