Effects Of Group Visits On The Health Status Of Hypertensive Nephropathy Patients In Community

ObjectiveTo explore the effects of the group visits on the health status of the hypertensive nephropathy patients in community.MethodsThere three states including the study.The first stage:A cross-sectional study design was conducted in this stage.151hypertensive nephropathy patients living in Dachang Community in Shanghai were enrolled by the non-probability sampling. The participants were interviewed by questionnaires including social demographic questionnaire, knowledge of hypertensive nephropathy questionnaire, Health-Promoting Lifestyle Profile II (HPLP II), Special Health-Promoting Lifestyle (SHPL), Self-efficacy Scale (SES). The data was analyzed by SPSS16.0.The second stage:A quasi-experimental study design was conducted in this stage. One hundred and eleven qualified patients were enrolled and assigned to intervention group (n=56) and control group (n=55). The intervention group patients received group visits for six months, while the control group received routine community health care. The knowledge, self-efficacy, health-promoting lifestyle scores, physical measurements and biochemical test results changes were compared by the SPSS16.0and SAS9.2.The third stage:A qualitative study design was conducted in this stage.10patients and6members of general practitioners team were invited to take part in the personal in-depth interview about their evaluation on group visits.Resultsl.Baseline survey:①The total score of knowledge was15.35±11.66(range from0to38), among that the hypertensive nephropathy basic knowledge was11.92±8.81(range from0to30), the prevention, treatment and nursing knowledge was3.43±3.34(range from0to12);②The HPLP II total score and the health responsibility domain, nutrition domain, stress management domain, physical activity domain, interpersonal relations domain and spiritual growth domain scores were124.99±24.91,18.35±5.62,24.26±3.95,20.77±4.78,16.69±5.91,23.81±5.84and21.10±6.22±; The score of SHPL total score was28.08±4.90;③The SES total score and the self-efficacy to manage symptoms domain, self-efficacy to manage diseases in general domain scores were38.06±9.17,25.75±6.50,12.31±3.64.④Linear multivariate regression analysis indicated that family financial status, family history of hypertension, way of medical care payment, knowledge and self-efficacy were the mainly related factors of health-promoting lifestyle among hypertensive nephropathy patients in community.2.The knowledge total score and two domain scores between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05); The knowledge total score and two domain scores were significantly different between the intervention group and the control group at the3months,6months after intervention.3. The results of repeated measures ANOVA showed that the SES total score and the self-efficacy to manage symptoms domain, self-efficacy to manage diseases in general domain scores exsited the group effect and the interaction effect between time factor and group factor (P<0.01or P<0.001). As is indicated by multivariate ANOVA, the SES total score and two domains scores were significantly different between the intervention group and the control group at the3months,6months after intervention (P<0.01or P<0.001), yet no statistic difference was found at the beginning of intervention (P>0.05).4.The results of repeated measures ANOVA showed that the HPLP Ⅱ total score the health responsibility domain, nutrition domain, stress management domain, physical activity domain, interpersonal relations domain and spiritual growth domiin scores and SHPL total score existed the group effect and the interaction effect between time factor and group factor (P<0.05, P<0.01or P<0.001). As is indicated by multivariate ANOVA, the HPLP Ⅱ total score and five domains scores were significantly different between the intervention group and the control group at the3months,6months after intervention(P<0.05), yet no statistic difference was found at the beginning of intervention (P>0.05).5.The results of repeated measures ANOVA showed that the values of systolic blood pressure, diastolic pressure, BMI, waist circumference and waist to hip ratio existed no group effect and interaction effect (P>0.05). As is indicated by multivariate ANOVA, the values of systolic blood pressure, diastolic pressure, BMI, waist circumference and waist to hip ratio between the intervention group and the control group had no statistic difference at the beginning of the intervention and3months,6months later (P>0.05).6.The results of repeated measures ANOVA showed that total cholesterol, triglycerides, LDL-C and HDL-C existed no group effect and interaction effect (P>0.05). As is indicated by multivariate ANOVA, the total cholesterol, triglycerides, LDL-C and HDL-C between the intervention group and the control group had no statistic difference at the beginning of the intervention and3months,6months later (P>0.05).7.The results of repeated measures analysis showed that the positive rates of serum Cys-C and MAU existed no group effect and interaction effect (P>0.05).8.Satisfaction survey:①The9items of patient satisfaction questionnaire scores were4.84±0.37,4.61±0.56,4.71±0.53,4.89±0.41,5.00±0.00,4.93±0.32,4.86±0.40,4.87±0.43and4.86±0.44;②The5iterms of primary care provider satisfaction questionnaire scores were4.17±0.41,4.33±0.52,4.67±0.52,4.50±0.84,4.67±0.52.9. Personal in-depth interview about the evaluation on group visits:①The patients and general practitioners team members showed high satisfaction with group visits.②Patients expressed that they changed their misconception, gained knowledge and self-management skill, changed unhealthy behaviors, improved their self-efficacy through group visits. General practitioners team members gained sense of accomplishment and accumulated work experience.③Group visits has its advantages and shortcomings.④Group visits is helpful to disease management.⑤Community nurses played important roles in group visits.Conclusion1.The community hypertensive nephropathy patients were lack of disease related knowledge. Their self-efficacy needs to be improved. The score of health-promoting lifestyles of them were in the general level.2.The group visits guided by self-efficacy theory could significantly impove disease related knowledge level, self-efficacy and health-promoting lifestyles among hypertensive nephropathy patients in community.3.The group visits guided by self-efficacy theory was feasible and provided support for community chronic management, which is worth to study further and popularize.