医保创伤患者心理状况影响出院意愿相关指标研究

发布时间：2018-03-05 16:30

本文选题：创伤　切入点：出院意愿　出处：《中南大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的探讨医保创伤患者的心理状况,并分析影响其出院意愿的因素,为提高患者出院依从及减少卫生服务的过度利用提供相关理论支持,以便减少过度卫生资源浪费,更好地完善全民医保。方法首先根据研究主题与研究内容进行广泛的文献检索与细读,通过文献梳理与数据整理对目前的已有的创伤患者心理健康及患者出院意愿等相关文献有初步了解同时进行总体描述,除了进行概念与理论上的梳理外,还重视实证调查的方法,通过采用结构性问卷和观察法对中南大学湘雅三医院及湖南湘雅博爱康复医院外科科室的136例创伤患者进行调查与定性访谈以采集信息资料,问卷包括基本资料、心理健康状况自评量表(SCL-90)、自尊量表(SES)、社交回避及焦虑量表(SAD)、艾森克人格个性问卷(EPQ)。在数据收集后使用统计学方法对数据进行处理,主要方法有信效度检验、描述性统计方法(频数、百分比或均数±标准差)、t检验、另外为了解出院意愿的相关影响因素,还采用多元LOGISTIC回归技术来对数据进行分析。结果(1)医保创伤患者SCL-90各因子分和总均分均高于普通人群,除躯体化、人际关系敏感、偏执与精神病性外,都有显著差异(P0.05),而不同出院意愿患者的差异出现在抑郁和焦虑的水平上(P0.05)。受测者自尊水平低于国内常模,但与出院意愿之间无相关性；社交回避与焦虑及人格方面相较于普通人群无差异性,与不同的出院意愿比较结果也未见差异性。医保创伤患者在PTSD症状分布上,主观评价创伤对精神的打击出现的几率最高,达到45.59%,其次为心悸、出汗、胸闷等不适,占43.38%,分布最低的为烦躁不安,占13.97%；回避症状方面,悲观失望比例最高,占33.09%,变得与信任感情疏远最低,占8.82%；警觉性增高方面,看到或听到与创伤有关的事情担心再度受伤比例最高,占32.35%,睡眠障碍最低,古8.09%；社会功能受损上,自觉学习或工作受影响占46.32%,感到内疚或有罪感仅古6.62%。不同出院意愿在PTSD-SS的量表总分、对创伤事件的主观评定和反复重现体验等多个维度上存在差异(P0.05)。(2)不同出院意愿的患者,其年龄、受学校教育年限、医保情况、创伤类型、住院天数(费用)、治疗效果存在着差异性(P0.05),而与性别、婚姻状况、工作状态未见统计学差异(P0.05)。(3)工伤与非工伤医保患者心理状况除SCL-90部分维度及PTSD的水平外(P0.05),其他量表的水平差异未见统计学意义(P0.05)；工伤医保患者相较于其他其他类型医保在职人数比例高、住院时长及次数较多、出院意愿较低。结论患者的心理健康程度会影响其出院意愿,为保障卫生服务的合理应用应当通过多种方式,如加强健康教育与心理干预,调整治疗方案,改善治疗措施等来矫正患者的不正常住院服务利用行为。
[Abstract]:Objective to explore the psychological status of patients with trauma in medical insurance, and analyze the factors influencing their willingness to leave the hospital, so as to provide relevant theoretical support for improving patients' compliance to discharge and reducing the over-utilization of health services, so as to reduce the waste of excessive health resources. Better improve health care for all. Methods first of all, extensive literature retrieval and detailed reading were carried out according to the subject and contents of the study. Through literature combing and data collation, there is a preliminary understanding of the existing trauma patients' mental health and patients' willingness to leave the hospital, and a general description is carried out at the same time, in addition to the conceptual and theoretical carding. It also pays attention to the method of empirical investigation. By adopting structural questionnaire and observation method, 136 trauma patients in the Department of surgery of Xiangya third Hospital and Hunan Boai Rehabilitation Hospital of Hunan Xiangya University were investigated and qualitative interviews were conducted to collect information and data. The questionnaire included basic data, mental health self-rating scale (SCL-90), self esteem scale (SES), social avoidance and anxiety scale (SADX), Eysenck Personality questionnaire (EPQ). After data collection, the data were processed by statistical method, and the main methods were reliability and validity test. Descriptive statistical method (frequency, percentage or mean 卤standard deviation) was used to analyze the data. In order to understand the related factors of discharge intention, multivariate LOGISTIC regression technique was used to analyze the data. Results 1) the scores of SCL-90 factors and total mean scores in patients with trauma in medical insurance were higher than those in the general population, except somatization, sensitivity of interpersonal relationship, paranoid ideation and psychosis. There were significant differences (P 0.05) between the patients with different discharge intention and depression and anxiety. The self-esteem level of the subjects was lower than that of the Chinese norm, but there was no correlation between the self-esteem level and the discharge intention. There was no difference in social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality. Up to 45.59, followed by palpitations, sweating, chest tightness and other discomfort, accounting for 43.38 points, the lowest distributed being fidgety, accounting for 13.97; in the aspect of avoidance symptoms, the proportion of pessimism and disappointment is the highest, accounting for 33.09, becoming the least alienated from trust and feeling, accounting for 8.82; and the aspect of increased alertness, Seeing or hearing things related to trauma is the highest proportion of people worried about re-injury, accounting for 32.35%, sleep disorder is the lowest, ancient 8.09; social function is damaged, Conscious study or work was affected in 46.32 patients who felt guilty or guilty only 6.62.There were differences in the total score of PTSD-SS scale, subjective assessment of traumatic events and repeated recurrence experience in different discharge intentions. Their age, school years, medical care, trauma type, hospitalization days (cost, treatment effect) were different (P 0.05), while with sex, marital status, There was no statistical difference in work status (P0.05N. 3) except for the SCL-90 dimension and the level of PTSD, there was no significant difference in the level of other scales between the work-related injury patients and the non-work-related insurance patients (P0.05P 0.05), and there was no significant difference in the level of other scales between the work-related injury patients and the non-work-related injury insurance patients compared with other categories. The number of people in employment is high, The length and frequency of hospitalization were more, and the intention of discharge was lower. Conclusion the mental health of patients will affect their willingness to discharge from hospital. In order to ensure the rational application of health services, we should strengthen health education and psychological intervention, adjust the treatment plan, Improve the treatment measures to correct the abnormal hospitalization service utilization behavior.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R641

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