搞好哮喘教育管理改变医疗服务模式

EnhancingtheeducationmanagementonAsthmachangingthemodelofmedicalservicePekingUniversityRenminHospitalHeQuanyingSomanyproblemsexistedinmedicalservice,why?Whatthesolutions?Difficulties:unfairlocationsofthemedicalresourcescountrysideurbanHighcost：differentformsformedicalcostnewdrugs’developmentslowlyincreasedofpeople’sincomeHealthreformthehospitaldevelopmentserviceforprofitUnhealthydoctor-patientrelationshipbecomesmoreandmoretension:trustlessrestrictingtheverydevelopmentofphysiciansWhy?Thewaypaidformedicalservicechangedconstitutionofthehospitals,professionalismeducation,medicalreform,ExcessiveMedicalCare,NegativefunctionofthemultimediamissionformedicineProfit---forpublichospitals,physicianslostthemselvesSeekingtomakeaprofitWorkpassivelyPromotingthehealthofall.inthiscomplicatedcontext,whatphysiciansshoulddo?how?theadministrationofAsthmabeganin1993inChina,aftermanyyears’practiceandexploration,thefollowingmodelformed.三三位位一一体体医医疗疗服服务务模模式式哮喘宣教中心哮喘专病门诊哮喘患者协会specialserviceforAsthmaistheprimarypointforeducationmanagementonAsthma.Physiciantherewillberesponsibleforthediagnosis,makingplanontreatmentandsoon.publiceducationcenteronAsthmaisthefurtherstep,itmakesmoreconveniencefordoctor-patientcommunications.Theassociationofasthmapatientsistheplatformwecarryoutoureducation,itprovidesaidealatmospherebetweendoctorandpatient.Doctor-patientrelationshipisthefatalfactorhere.TheassociationofasthmapatientsfoundedinMay,2001.Morethan700membersnow.Anactivitywillbeholdatweekendeveryfourmonths(free).Memberswillbeinformedandtakepartinastheywant.Always100-150members.Content:LecturesonAsthmacontrol;Communicationbetweenasthmapatients,etc.Itwillbechangeddependonthemembers’willing,butalwaysconcentrateontheAsthmacontrol&AsthmacontrolinChina.“PubliceducationcenteronAsthma”foundedinNov,2001.Aspecialistgivesadvise,alsosometrainingtohispatientsgivepatientsfreematerialsdevelopvolunteersmakeupfiles,etc.“specialserviceforAsthma”beganinApril,2003.Aspecialistwillprovidehisservices.patientsgettheirdiagnosisandrelativetreatmentplan;knowmoreonAsthma;alsohavemoreconfidence.relativeactivitiesofdoctorsonAsthmaLongtermtreatmentforAsthmacontrolandmanagementevaluatingWorkingforgoalsMonitorandmaintainthecontrolin2005表1thebasicknowledgeknownbypatients分组调查人数哮喘是一种慢性疾病哮喘变应性炎症本质激素是控制气道炎症最有效药物吸入疗法用药的优点吸入型药物正确用法峰速仪为监测病情重要工具哮喘控制目标预防诱因重要性人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）教育组7373100.06183.66690.473100.07298.66893.27197.36791.8对照组302066.7620.01343.31963.32686.7620.01860.02376.7x2值23．2837．7826．3726．254．2556．2422．264．40P值0.010.010.010.010.050.010.010.05表2thecorporationbetweendoctorandpatient分组调查人数信任经治医生选择固定医师完全服从治疗方案能够定期随访人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）教育组736994.56082.24865.84865.8对照组302686.7413.31033.31240.0x2值0.9039.99.085.79P值0.050.010.010.05表3activitiestakenbypatients分组调查人数曾经坚持3个月以上吸入激素仍然坚持吸入激素吸入方法正确拥有峰速仪经常监测峰流速个人记录峰流速值峰流速记录供医生参考注意预防哮喘诱因人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）人数构成比（％）教育组736994.56082.27298.65778.13547.93142.52534.26791.8对照组301136.71736.72686.7826.713.313.313.32376.7x2值37.7620.584．2524.1418．6115．2010．774.40P值0.010.010.050.010.010.010.010.05表4thecontrolofAsthma分组调查人数白天症状(≤2天/周)无因哮喘夜间扰醒日常活动不受限按需用β2激动剂(≤2天/周,且≤4次/周)病情无急性加重无急诊或住院无治疗相关不良反应而改变治疗良好控制人数构成比（％）人数构成比人数构成比人数构成比人数构成比人数构成比人数构成比人数构成比教育组565089.34987.55292.94580.43969.656100.056100.03460.7对照组302273.31240.01860.01446.7826.72273.330100.0310.0x2值3．6521．3813．9310．3014．5613．46－20．50P值0.050.010.010.010.010.010.050.01表5lifequalityevaluationforpatientsofAsthma分组调查人数活动受限（60）哮喘症状（40）心理状况（30）＊对刺激原反应（25）对自身健康的关心（20）哮喘生命质量总分（175）教育组5650±637±327±324±217±3155±12对照组3044±1031±623±521±413±4132±24t值3．335．334．943．264．925．17P值0.010.010.010.010.010.01表6hospitalmedicalresourcesusingbypatients分组调查人数非预约门诊就医急诊就医住院人数构成比（％）人均次数人数构成比（％）人均次数人数构成比（％）人均次数教育组56916.10.5±1.747.10.2±0.623.60.1±0.3对照组302066.72.1±2.81240.00.6±0.9413.30.2±0.7t值4.823.551.69x2值22．3813．931．56P值0.010.010.010.010.050.05In2006表7patients’knowledge&informationlevelonAsthma分组例数认为哮喘本质是气道慢性炎症性疾病例（％）认为持续期每日均应规律使用的一线药物是吸入型糖皮质激素例（％）认为哮喘可以被长期控制例（％）教育组10095(95%)95(95%)95(95%)对照组427272(64%)182(43%)316(74%)x2值37.54389.14620.805P值0.010.010.01表8activitiestakenbypatientsforAsthmacontrol分组例数曾接受过肺功能测定例（％）拥有医生制定的长期治疗计划例（％）每日坚持规律吸入糖皮质激素例（％）拥有呼气峰流速仪例（％）每日监测呼气峰流速例（％）曾吸烟人数例（％）12(12%)94(22%)5.2550.05已戒烟人数例（％）教育组10093(93%)91(91%)82(82%)42(42%)11(11%)12(12%)7(58%)对照组427339(79%)166(39%)232(54%)80(19%)21(5%)94(22%)29(31%)χ2值3．3310.15588.10925.75524.6505.2555.057P值0.010.010.010.010.010.050.05表9theconditioncontrol分组例数哮喘控制测试（ACT）评分≥20分例（％）过去一年中因哮喘加重住院例（％）过去一年中因哮喘加重看急诊例（％）在职患者例（％）过去一年中因哮喘误工例（％）教育组10085(85%)4(4%)18(18%)49(49％)10(20％)对照组427159(37%)99(23%)136(32%)137(32％)76(55％)χ2值3．3374.34519.4317.5154.678P值0.010.010.010.010.05publishedin2005,theAsthma,neversaygoodbye---fromtheAsthmapatientsonOct.11st,2007theMinistryofPublicHealthCertificatedourtriesonAsthmaeducationafteryears’exploration,itistheAsthmaitselfthatistheveryenemyofmine,theconcentrationshouldnotbethedoctor-patientresistance.unregulate