COPD患者感知的慢性病管理水平、自我管理能力与生活质量的相关性研究

发布时间：2018-01-25 17:53

本文关键词： COPD 慢性病管理水平自我管理能力生活质量　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是呼吸系统常见的慢性病之一,因其具有较高的患病率和病死率,会严重影响患者的劳动能力和生活质量,从而给家庭和社会都造成了巨大的压力和经济负担。这就需要引起我们足够的重视,并开展更多的研究去解决和应对其引起的相关问题。就目前我国的慢性病管理形式来说,虽然在高血压、糖尿病等方面取得的一定成效,但COPD的慢性病管理,仍存在欠缺和不足,没有形成完善的管理模式,更需要摸索和建立符合我国国情和特色的COPD慢性病管理体系。目的了解COPD稳定期患者慢性病管理水平、自我管理能力、生活质量的现状和三者之间的关系,为今后临床制定有效的健康教育措施提供更好的参考依据。方法采用横断面调查的方法选取2015年7月至2016年6月曾在山东省济南市某三级甲等医院呼吸内科就诊的COPD患者运用问卷调查表进行调查。问卷内容包括COPD患者一般资料调查表、COPD患者自我管理量表、慢性病管理评价量表、COPD患者生活质量问卷。采用SPSS Statistics 21.0以及SPSS Amos 21.0软件对数据进行统计和分析。结果1.慢性病管理量表平均为(3.00±0.57)分,问题解决/连贯性维度平均为(3.34±0.77)分;其中患者主动性、服务系统设计/实践设计、目标设定/因人施治、随访/协作四个维度的中位数分别为:3.33、2.67、2.90、2.40。2.COPD患者自我管理量表总分最低95分,最高238分,平均为(160.3±25.56)分;自我管理能力中等者占63.6%(126例),自我管理能力高者占18.7%(37例),自我管理能力低者占17.7%(35例)。3.COPD患者生活质量问卷得分最低为2分,最高为20分,平均为(10.51±3.93)分,生活质量根据得分高低可分为四个等级,50%的患者生活质量处于较差及以下水平,35.9%的患者生活质量处于中等水平,仅有14.1%的患者生活质量处于较好水平。4.不同人口学特征的生活质量得分的差异有统计学意义。结果显示不同婚姻状况、居住地、教育程度、家庭月收入、COPD严重程度的COPD患者的生活质量得分差异具有统计学意义(P0.05);年龄与生活质量得分呈正相关(r=0.460)。5.COPD患者生活质量回归分析结果显示:COPD患者的年龄、家庭月收入和感知的慢性病管理水平最终进入回归模型,可解释COPD患者生活质量得分总变异的64.6%。其中患者感知的慢性病管理水平对COPD患者的生活质量影响最大,与生活质量得分呈负性相关(标准化回归系数=-0.641)。6.COPD患者感知的慢性病管理量表总分与生活质量得分呈显著高度负相关(r=-0.739,P0.01)。7.COPD患者自我管理量表总分与生活质量得分呈显著负相关(r=-0.608,P0.01)。8.患者感知的慢性病管理量表总分、患者主动性、目标设定/因人施治、问题解决/连贯性、随访/协作维度与COPD患者自我管理量表总分及其各分维度呈现显著正相关,而服务系统设计/实践设计维度与患者的日常生活管理维度却没有明显的相关性。9.路径分析显示,COPD患者自我管理能力是患者感知的慢性病管理水平和生活质量之间的中介因素,即患者感知的慢性病管理水平既能直接对其生活质量产生影响,还能通过提高COPD患者自我管理能力间接改善其生活质量。结论1.总体来看COPD患者感知的慢性病管理水平一般;2.COPD患者的自我管理能力总体处于中等水平,其中自我管理能力中等者占 63.6%;3.COPD患者生活质量普遍较差,50%的患者生活质量处于较差及以下水平;4.COPD患者自我管理能力是感知的慢性病管理水平和生活质量之间的中介因素。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD) is one of the most common chronic disease of respiratory system, because of its high morbidity and mortality, will seriously affect the ability to work and quality of life of the patients, and to the family and society have caused enormous pressure and economic burden. This requires the cause we have enough attention, and carry out more research to solve and deal with the related problems. The present form of chronic disease management in China, although some achievements have been made in hypertension, diabetes and other aspects of the COPD, but the management of chronic diseases, there are still gaps and deficiencies, has not formed the perfect management mode, more need to explore and establish China's national conditions and characteristics of COPD in chronic disease management system. To investigate the COPD in patients with stable chronic disease management, self management ability, quality of life and status The relationship between the three, to provide a better reference for the future development of clinical health education measures. Methods a cross-sectional survey from July 2015 to June 2016 in Shandong city of Ji'nan Province three level of first-class hospital respiratory medicine clinic COPD patients by questionnaire survey. The questionnaire included COPD patients with general information questionnaire, self the management of COPD patients, chronic disease management evaluation scale, scale, quality of life in patients with COPD questionnaire. Using SPSS Statistics 21 and SPSS Amos 21 software was used for statistics and analysis of data. Results of the 1. chronic disease management scale average (3 + 0.57) points, solve the problem of dimension / Coherence Average (3.34 + 0.77) among the patients; initiative, service system design / design practice, goal setting / person / median follow-up treatment, the four dimensions of cooperation are: 3.33,2.67,2.90,2.40.2 Self management of patients with.COPD score a minimum of 95 points, the highest 238 points, an average of (160.3 + 25.56); the self management ability of middle accounted for 63.6% (126 cases), self management ability accounted for 18.7% (37 cases), low self management ability accounted for 17.7% (35 cases) of patients with.3.COPD quality of life questionnaire the lowest score was 2 points, up 20 points, an average of (10.51 + 3.93), quality of life can be divided into four levels according to the scores, 50% of the patients life quality is poor and low level, 35.9% of the patients' quality of life in the middle level, the difference was statistically significant in only 14.1% of patients in the quality of life different demographic characteristics better level of.4. quality of life score. The results showed that different marital status, residence, education level, family income, with statistical significance of the severity of COPD in patients with COPD quality of life score difference (P0.05); the age and quality of life The relevant amount were positive (r=0.460) quality of life of patients with the results of.5.COPD regression analysis showed that COPD patients age, chronic disease management level of family income and perception into regression model, can explain the quality of life in patients with COPD scores of the total variation of 64.6%. among patients with chronic disease management knowledge of the sense of the greatest impact on the life quality of patients with COPD and negatively correlated with the quality of life score (standardized regression coefficient =-0.641).6.COPD patients' perception of chronic disease management scores and life quality scores were significantly negatively correlated (r=-0.739, P0.01).7.COPD patients self management scale was negatively correlated with total score of quality of life score (r=-0.608, P0.01).8. patients perception the management of chronic disease score, patient initiative, goal setting / human treatment, problem solving / consistency, follow-up / dimension of cooperation with COPD patients self management scale and It shows a significant positive correlation of each factor, and service system design / management practice of the daily life dimension of the design dimensions and patients has no correlation significantly.9. path analysis shows that the self management ability of COPD patients is a mediating factor between the perception of patients of chronic disease management level and quality of life, namely the perception of patients of chronic disease management level can have a direct impact on the quality of life, also can improve the ability of self management of patients with COPD indirectly improve their quality of life. Conclusion the level of chronic disease management of patients with COPD 1. overall perception; 2.COPD patients self management ability overall in the medium level, the ability of self management medium accounted for 63.6%; the quality of life in 3.COPD patients is generally poor. 50%, the quality of life of patients is poor and low level; the ability of self management of patients with 4.COPD is aware of chronic disease management and health Mediating factors between living quality.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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