杭州市医养护一体化服务模式下社区失能老人健康问题的随访研究

发布时间：2018-10-08 12:52

【摘要】：目的:评估医养护一体化服务模式下社区失能老人现存的健康问题及其对每个健康问题的认知、所采取的行为、健康问题的状态的变化。方法:1.调查方法:本研究采取便利抽样的方法,运用国际标准化护理语言—奥马哈系统对杭州市某社区卫生服务中心签约医养护一体化服务的80名失能老人现存的健康问题及其每个健康问题的认知、行为、状态进行评估。第一次评估为失能老人签约但未接受医养护一体化服务时,之后评估每两个月一次,共四次,每次评估时间约1 h、持续时间为六个月。同时,为了使评估资料更加全面,本研究在完成评估后增加一个开放性问题:根据您自身的情况,您认为您主要的健康问题有哪些?2.统计学方法:本研究使用描述性分析(均数、标准差、频数、构成比)描述社区失能老人的一般信息,现存的健康问题,社区失能老人现存的每个健康问题的认知、行为、状态情况。社区失能老人现存的健康问题的认知、行为、状态的变化情况采用Friedman检验(简称M检验)。结果:1.第一次评估为社区失能老人刚签约医养护一体化服务时,发现社区失能老人存在(12.7±3.13)个健康问题,第二次评估时发现(12.3±2.89)个健康问题,第三次评估时发现(12.2±2.74)个健康问题,第四次评估时发现(12.2±2.75)个健康问题。2.四次评估中共同存在的常见健康问题(发生率≥50%的健康问题):环境领域为住宅问题;心理社会领域为社交问题和精神健康问题;生理领域为视觉问题、口腔卫生问题、认知问题、神经-肌肉-骨骼功能问题;健康相关行为领域为身体活动问题和个人照顾问题。3.随着时间的推移,签约医养护一体化服务的社区失能老人在社交问题、精神健康问题、口腔卫生问题、循环问题的认知得分增加有统计学意义(P0.05),循环问题的行为得分增加有统计学意义(P0.05),社交问题、神经-肌肉-骨骼功能问题、循环问题的状态得分增加有统计学意义(P0.05)。结论:1.签约医养护一体化服务的社区失能老人的健康问题多(在42个健康问题中,平均每名失能老人存在约13个健康问题),社区失能老人的常见健康问题的行为和状态较认知差。2.医养护一体化服务可能有助于改善社区失能老人的社交问题、精神健康问题、口腔卫生问题、循环问题的认知,循环问题的行为以及社交问题、神经-肌肉-骨骼功能问题和循环问题的状态。而尚未发现医养护一体化服务对社区失能老人其他健康问题的改善效果。
[Abstract]:Objective: to evaluate the existing health problems of the elderly with community disability and the changes of their cognition, behavior and state of health problems under the model of integrated medical and conservation services. Method 1: 1. Methods of investigation: this study adopts a convenient sampling method, An international standardized nursing language-Omaha system was used to evaluate the existing health problems and the cognition, behavior and status of 80 disabled elderly people who were contracted by a community health service center in Hangzhou. The first assessment was for the disabled but did not accept the integrated medical care service, and then every two months, a total of four times, each assessment time is about 1 hour, the duration is six months. At the same time, in order to make the assessment more comprehensive, this study adds an open question to the completion of the evaluation: what do you think are your major health problems based on your own situation? 2. Statistical methods: this study uses descriptive analysis (mean, standard deviation, frequency, composition ratio) to describe the general information about the disabled elderly in the community, the existing health problems, the cognition and behavior of each of the existing health problems of the disabled elderly in the community. Status. The changes of cognition, behavior and state of the existing health problems of the disabled elderly in the community were tested by Friedman test (M test for short). The result is 1: 1. In the first assessment, when the community disabled people signed up for the integrated medical care service, it was found that there were (12.7 卤3.13) health problems in the community disabled elderly, (12.3 卤2.89) health problems in the second assessment, and (12.2 卤2.74) health problems in the third assessment. The fourth assessment found (12.2 卤2.75) health problems. Common health problems common in the four assessments (health problems with a prevalence rate of more than 50 per cent): residential problems in the environmental field; social and mental health problems in the psychosocial field; visual and oral health problems in the physical field, Cognitive problems, neuro-muscle-bone function problems; health-related behavioral issues: physical activity problems and personal care problems. Over time, the community incapacitated elderly signed up for an integrated medical care service had social problems, mental health problems, oral health problems, The cognitive scores of circulatory problems increased significantly (P0.05), the behavioral scores of circulatory problems increased significantly (P0.05), social problems, neuromusculoskeletal function problems and circulatory problems state scores increased significantly (P0.05). Conclusion 1. The health problems of the disabled elderly in the community were more than those in the community with integrated medical and maintenance services (of 42 health problems, there were about 13 health problems per disabled elderly on average), and the behavior and state of the common health problems of the disabled elderly in the community were worse than that in the community. 2. Integrated health care services may help improve social problems, mental health problems, oral health problems, circulatory problems, behavior of circulatory problems, and social problems in the community. The state of neuromuscular-skeletal problems and circulatory problems. However, the effect of integrated medical and maintenance services on other health problems of disabled elderly in the community has not been found.
【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.2

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