慢性丝虫病患者社区照料及疾病经济负担调查

发布时间：2018-01-17 14:39

本文关键词：慢性丝虫病患者社区照料及疾病经济负担调查　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的为了解震泽镇消除丝虫病后慢性丝虫病患者的患病、转归、关怀照料效果以及疾病经济负担情况，从而为进一步做好关怀和照料慢性丝虫病患者工作提供科学依据。方法以苏州市吴江区震泽镇50周岁以上的常住居民为调查对象，采用现况研究方法对慢性丝虫病患者现况进行调查，结合配比病例对照研究方法对慢性丝虫病患者和非慢性丝虫病人群进行疾病经济负担影响因素调查。采用统一设计的调查表，由经过统一培训的镇医院医护人员进行面对面询问并填写调查表，对慢性丝虫病的患者的一般情况（性别、年龄、户口所在地、本地累计居住时间、文化程度、职业、医疗保障、疾病健康状况等）、随访情况（双腿象皮肿程度、流火年发作次数、病程、好发季节、诱因、治疗及照料情况等）、经济状况（个人全年纯收入、家庭全年纯收入、共享收入人口数、居住面积、共居人口数、是否为低保户）、医疗花费（自我医疗花费、就诊医疗花费、间接医疗花费）进行调查。原始资料经核对后使用Epidata3.0软件进行双人双机录入，录入后的资料经逻辑核查无误后统一转化为SPSS18.0数据库，采用SPSS18.0软件进行统计分析。计量资料用均数（）±标准差（S）表示，计数资料以构成比或率表示，组间比较采用2检验或用t检验进行统计推断。结果 1、震泽镇1998年消除丝虫病后，无新发慢性丝虫病患者；原慢性丝虫病患者764例，至2013年尚存117例，分别比基本消除丝虫病和2002年普查时自然减少84.68%、44.81%，分布区域已明显缩小；遗留的患者年龄以70～79岁老年人居多，占58.12%；患者病程多在50～59年，占54.70%；淋巴液肿部位和分期以右下肢和Ⅱ～III期为主，分别占整个病例的40.17%、46.16%。 2、通过社区、家庭/自我照料后，现存117例慢性丝虫病患者淋巴水肿分期高的患者逐渐减少，分期低的患者增多，与照料前相比较，差别具有统计学意义(＜0.05)，，说明病情好转，且患者下肢淋巴管/结炎、急性大、小发作和下肢溃疡的发生情况明显好转（P＜0.05）。 3、震泽镇慢性丝虫病患者的个人年纯收入、家庭纯收入、共享收入人口数、居住面积、共同居住人口数、是否低保户等6项经济情况与未患病组相仿，两组间差别无统计学意义（均P＞0.05）。 4、慢性丝虫病患者的医疗花费除家属陪同费用和患者误工费用外，自我医疗、直接医疗（门诊费、住院费）、间接医疗(交通费、住宿费)均大于未患丝虫病组，两组间总体医疗费用的差别有统计学意义（均P＜0.001）。自我医疗、直接医疗（门诊费、住院费）的自付比例，患病组均大于未患病组，差别有统计学意义（均P＜0.001）。结论 1、震泽镇消除丝虫病后，慢性丝虫病患者明显减少，表现为高龄化、病程长的特点。 2、采用WHO推荐的社区、家庭/自我照料措施，能够改善慢性丝虫病患者的病情，阻止疾病的进展，照料效果肯定，推荐在基层社区推广。 3、震泽镇慢性丝虫病患者的经济收入状况与未患慢性丝虫病人群相仿。 4、震泽镇慢性丝虫病患者各项医疗花费（除家属陪同费用和患者误工费用外）均高于未患丝虫病人群，自付比例也明显高于未患丝虫病人群。建议政府部门给予这部分人群特殊医疗救助或者提高报销比例。
[Abstract]:objective
In order to understand the Zhenze town after filariasis elimination in patients with chronic filariasis patients, care effect and economic burden of disease, so as to provide scientific basis for the improvement of care and work in patients with chronic filariasis.
Method
The residents of Zhenze town of Wujiang District of Suzhou city for more than 50 years of age for the survey, the current research methods to investigate the status of patients with chronic filariasis, matched case-control study method of disease economic negative factors on the load survey of patients with chronic filariasis and non chronic filariasis patients. With unified questionnaire, face-to-face inquiry and fill out the questionnaire by the medical staff trained town hospital, the general situation of chronic filariasis patients (gender, age, residence, local residence time, education, occupation, medical security, health and other diseases), follow-up (legs elephantiasis, Liuhuo years episodes, duration well, the season, causes, treatment and care etc.), economy (personal annual net income, average annual family income, the share of income population, living area, a total of In the population, whether households), medical expenses (self medical expenses, medical expenses, indirect medical costs) were investigated. The original data were checked using Epidata3.0 software double dual input, input the data after the logic verification is correct after unified into the SPSS18.0 database, using SPSS18.0 software for statistical analysis by mean of measurement data (standard deviation) (S) said the count data expressed as a proportion or rate, comparison between groups using the 2 test or t test was used for statistical inference.
Result
In 1998 1, Zhenze town after filariasis elimination, no new cases of chronic filariasis patients; 764 cases of primary chronic filariasis patients surviving to 2013 117 cases, respectively than the basic elimination of filariasis and 2002 census natural distribution area decreased by 84.68%, 44.81%, has been significantly reduced; the remaining patients aged 70 to 79 years old are 58.12%; patients accounted for 54.70% in 50 to 59 years; the swollen lymph site and stage to the right lower extremity and II ~ III, accounted for 40.17% of cases, 46.16%.
2, through the community, family / self care, 117 cases of existing chronic filariasis patients with lymphedema in patients with high stage decreased, increased low stage patients, compared with care before, the difference was statistically significant (P < 0.05), indicating the condition improved, and patients with lower limb lymphatic node / inflammation, acute. Small seizures and lower limb ulcer improved (P < 0.05).
3, personal annual income of Zhenze town of patients with chronic filariasis, family income, revenue sharing population, living area, living in a common population, whether low household economic situation and 6 unaffected groups are similar, the difference between the two groups was not statistically significant (P > 0.05).
4, the cost of medical treatment in patients with chronic filariasis patients accompanied by family members costs and delay costs, self care, medical (outpatient fees, hospitalization expenses), indirect medical (transportation fees, accommodation fees) were higher than those of patients in group, the two groups have significant differences in overall medical costs (P < 0.001) self care, medical (outpatient fees, hospitalization fee) the proportion of payment, disease group were higher than those in group, the difference was statistically significant (P < 0.001).
conclusion
1, Zhenze town of elimination of filariasis after chronic filariasis patients decreased significantly, as aging, the characteristics of long duration.
2, using WHO recommended family / family care measures can improve the condition of chronic filariasis patients, prevent disease progression, and ensure the effect of care. It is recommended to promote in the grass-roots community.
3, the economic income of Zhenze town of patients with chronic filariasis patients with chronic filariasis group is similar.
4, Zhenze town of chronic filariasis patients with various medical costs (except families accompanied by costs and patient delay costs) were higher than those of patients without filariasis patients group, pay a significantly higher proportion of patients without filariasis patients group. Suggest the government departments to give this part of the crowd or special medical assistance to improve reimbursement.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R532.15

【参考文献】