居家老年心血管病患者参与用药安全管理方案及应用研究

发布时间：2018-03-15 08:47

本文选题：老年　切入点：心血管疾病　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的构建适合居家老年心血管病患者参与用药安全管理的分阶段渐进性干预方案,并验证方案的可行性及有效性。方法本研究共分两个阶段。1.干预方案构建阶段:基于国内外相关文献分析,前期居家老年慢性病患者参与用药安全的质性研究,在动机性访谈及互动式患者参与患者安全理论框架的基础上,初步构建干预方案。通过专家咨询,并对纳入研究对象的用药差错现状进行分析,结合预试验,确定一套操作性较强、较易被接受的患者参与用药安全管理方案。2.干预方案实施阶段:2015年12月~2016年12月,选取郑州市林山寨社区卫生服务中心的8个居民社区,以社区为单位,按人数多少进行匹配,两个社区为一组,分成四组,然后从每组中使用抽签法随机选一个进入干预组,另一个进入对照组。最终干预组51例,对照组53例。干预组实施患者参与用药安全管理方案,共12周;对照组前3周健康教育同干预组,其余周次进行常规随访。采用用药差错调查表、合理服药自我效能量表(Self-efficacy for Appropriate Medication Use Scale,SEAMS)及患者积极度量表(Patient Activation Measure,PAM)评价干预方案对居家老年心血管病患者参与用药管理的用药差错程度、合理服药自我效能及积极度的影响,分别于干预前、干预后、干预后1个月及3个月收集资料。采用IBM SPSS Statistics 21.0软件分析数据,方法有描述性统计分析、t检验、卡方检验、Kruskal-Wallis秩和检验、多重对应分析、广义估计方程、重复测量方差分析。结果共纳入研究对象120例,样本流失16例,流失率13.3%,有效样本量104例。纳入研究对象年龄65~87岁,平均年龄(73.25±5.40)岁。干预组(n=51)平均年龄(73.86±4.25)岁,对照组(n=53)平均年龄(72.66±6.29)岁。1.采用广义估计方程分析7种用药差错类型的变化情况:(1)存在组间效应的用药差错类型有:遗漏差错(Waldχ~2=47.223,P0.001)、时间差错(Waldχ~2=31.371,P0.001)、剂量差错(Waldχ~2=35.759,P0.001)、未授权差错(Waldχ~2=6.773,P=0.009)、不依从医嘱差错(Waldχ~2=4.319,P=0.038)及监控差错(Waldχ~2=6.755,P=0.009)。(2)不存在组间效应的用药差错类型有:未关注处方差错(Waldχ~2=1.834,P=0.176)。(3)存在时间效应的用药差错类型有:未关注处方差错(Waldχ~2=74.437,P0.001)、遗漏差错(Waldχ~2=112.197,P0.001)、时间差错(Waldχ~2=114.940,P0.001)、剂量差错(Waldχ~2=100.171,P0.001)、未授权差错(Waldχ~2=70.691,P0.001)、不依从医嘱差错(Waldχ~2=77.856,P0.001)及监控差错(Waldχ~2=87.052,P0.001)。随时间增加,遗漏差错、时间差错及剂量差错程度降低后保持不变;未关注处方差错、不依从医嘱差错及监控差错程度有递增趋势;患者未授权差错程度先降低后增加,干预后3个月与基线相比差异无统计学意义(P=0.102)。2.合理服药自我效能量表得分的重复测量方差分析结果显示,存在组间效应(F=31.632,P0.001)和时间效应(F=832.994,P0.001),且测量前后组间效应与时间效应存在交互作用(F=367.434,P0.001)。交互轮廓图显示,随时间延长,干预组合理服药自我效能得分有下降趋势。3.干预后干预组患者积极度总分均大于对照组患者积极度总分,差异有统计学意义(P0.001),进一步分析可知:(1)重复测量方差分析结果显示,存在组间效应(F=42.698,P0.001)和时间效应(F=305.557,P0.001),且测量前后组间效应与时间效应存在交互作用(F=270.424,P0.001)。交互轮廓图显示,随时间延长,干预组患者积极度得分有下降趋势。(2)采用广义估计方程分析两组患者不同积极度水平的人数情况,存在组间效应(Waldχ~2=24.553,P0.001)和时间效应(Waldχ~2=38.474,P0.001),且随时间增加,患者积极度水平有下降趋势。结论1.患者参与用药安全管理方案易接受、可操作性较强,可充分调动患者积极性,促使其主动参与或在家属协助下主动参与自身用药安全的管理。2.实施患者参与用药安全管理方案后,可降低居家老年心血管病患者常见用药差错类型的差错程度,提高患者合理服药自我效能与患者积极度。
[Abstract]:Objective to construct a progressive intervention program in stages for patients with cardiovascular disease in the elderly medication safety management, and verify the effectiveness and feasibility of the scheme. The research method is divided into two stages: construction stage.1. intervention program based on the analysis of the related literature at home and abroad, a qualitative study of early home elderly patients with chronic diseases in drug safety. Based on motivational interviewing and interactive patient safety on the theoretical framework, constructs the intervention program. Through expert consultation, and included in the study of the status quo of error analysis, combined with the pre test, determine a set of operational, is easily accepted by patients in the implementation of safety management scheme of.2. intervention project phase: December 2015 ~2016 year in December, selected 8 residents of Zhengzhou community forest copycat community health service center, community as a unit, according to the number of how many Matching, two community as a group, divided into four groups, then from each group were randomly selected using a into the intervention group, another into control group. 51 cases in the intervention group, 53 cases in the control group. The intervention group patients participating in drug safety management program, a total of 12 weeks; the control group 3 the same week health education intervention group, the remaining weeks were followed up. The reasonable medication medication errors questionnaire, self efficacy scale (Self-efficacy for Appropriate Medication Use Scale, SEAMS) and the patients with positive scale (Patient Activation Measure, PAM) to evaluate the degree of medication errors intervention on cardiovascular disease in elderly patients at home medication management. Reasonable medication self-efficacy and positive impact of the intervention, before intervention, respectively, after 1 months and 3 months to collect data. Data analysis using IBM SPSS Statistics 21 software, a descriptive statistical method Statistical analysis, t test, chi square test, Kruskal-Wallis rank test and multiple correspondence analysis, generalized estimating equations, analysis of variance of repeated measurement. Results a total of 120 subjects, 16 cases of sample loss, the loss rate is 13.3%, the effective sample size of 104 cases were included in the study. The age of 65~ 87, the average age (73.25. At the age of 5.40). The intervention group (n=51) the average age (73.86 + 4.25), control group (n=53) the average age (72.66 + 6.29).1. using generalized estimating equations and analyze the changes of 7 kinds of error types: (1) error types exist between group effects: the omission errors (Wald x ~2=47.223, P0.001), time error (Wald x ~2=31.371, P0.001), dose error (Wald x ~2=35.759, P0.001), unauthorized error (Wald x ~2=6.773, P=0.009), compliance order error (Wald x ~2=4.319, P=0.038) and monitoring error (Wald x ~2=6.755, P=0.009). (2) there were no the difference between the effect of medication Wrong type: not on prescription errors (Wald x ~2=1.834, P=0.176). (3) error types exist time effect are: not prescription errors (Wald x ~2=74.437, P0.001), omission errors (Wald x ~2=112.197, P0.001), time error (Wald x ~2=114.940, P0.001), dose error (Wald x ~2=100.171, P0.001), unauthorized error (Wald x ~2=70.691, P0.001), compliance order error (Wald x ~2=77.856, P0.001) and monitoring error (Wald x ~2=87.052, P0.001). With the increase of time, the omission errors remain unchanged, time error and dose error decreased; not prescription errors, not order error and error monitoring compliance degree of patients have an increasing trend; unauthorized error degree decreased firstly and then increased, 3 months after the intervention compared with the baseline, there was no statistically significant difference (P=0.102).2. reasonable medication self-efficacy results of repeated measurements analysis of variance scores showed that there The effect between the groups (F=31.632, P0.001) and the effect of time (F=832.994, P0.001), and there was an interaction between the groups before and after the measurement and time effects (F=367.434, P0.001). The interaction profile, with the extension of time, the intervention group score reasonable medication self-efficacy had declined after intervention in the intervention group patients with positive.3. score were higher than the control group in patients with a positive score, the difference was statistically significant (P0.001), further analysis shows that: (1) repeated measures analysis of variance showed that there were effects (F=42.698, P0.001) and the effect of time (F=305.557, P0.001), and there was an interaction between the groups before and after the measurement and time effects (F=270.424. P0.001). Interactive contour maps show that with time, patients in the intervention group positive scores decreased. (2) using generalized estimating equation analysis of the number of different levels of extreme product in two groups, there were effects (Wald X ~2=24.553, P0.001) and time effect (Wald x ~2=38.474, P0.001), and increased with time, with positive level decreased. Conclusion the 1. patients involved in drug safety management program is easy to accept, strong operability, can fully mobilize the enthusiasm of patients, promote their active participation in the implementation or patients involved in drug safety management program in the family assistance to actively participate in its drug safety management.2., can reduce the error level of patients with common cardiovascular disease in elderly patients with type of medication errors, improve medication self-efficacy in patients with active and reasonable degree.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.2

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