| Objective(1)Understand the utilization of health services and economic burden of gastric cancer patients in Anhui Province;(2)Analyze the related factors of gastric cancer;(3)Summarize the related coping defects of gastric cancer patients and to select the intervention target behavior;(4)Edit intervention SMS and to design dynamic web pages and formulate a preliminary plan for remote intervention of psychological behavior of gastric cancer patients.Methods(1)The hospitalization expenses data of gastric cancer patients in the reimbursement system of new rural cooperative medical system in Anhui Province from2013 to 2017 were selected to describe the number of gastric cancer patients,technical level of hospital,length of stay,current situation and composition of hospitalization expenses.(2)The inpatient medical records of patients with gastric cancer were recorded in three hospitals in Anhui province,and the relevant data,such as medical expenses and examination items,were extracted for statistical description.(3)A case-control study was conducted based on the household questionnaire survey data from January 2016 to August 2019 in Fuyang City,Hefei city and Huangshan City,Anhui Province.Frequency,chi square test,logistic regression and other statistical methods were used to analyze the influencing factors of gastric cancer.Odds ratio(OR)was used to analyze the interaction between multiple factors.The suspicious influencing factors with or > 1 were identified as the independent risk factors of primary gastric cancer(P<0.05).(4)Qualitative interviews were conducted among 24 patients with gastric cancer to analyze and summarize the disease coping behavior defects of patients with gastric cancer.(5)On the basis of the above research results,edit the intervention message template for gastric cancer patients,and formulate the preliminary program of psychological and behavioral remote intervention for gastric cancer patients guided by Health Belief Model and AI.Results(1)A total of 32095 hospitalized patients with gastric cancer in Anhui Province from 2013 to 2017 were included in the analysis of health service utilization and disease economic burden of gastric cancer patients,with a total reimbursement of 77551 person times.During the five years,the number of inpatient reimbursement for gastric cancer increased year by year,and the proportion of inpatient reimbursement in tertiary hospitals was the highest(50%);the length of stay decreased year by year,stable at about 10 days.There were statistical significant differences in the number of inpatients and length of stay among different levels of hospitals(P < 0.05).From 2013 to 2015,the average total medical expense per time for gastric cancer inpatients showed an upward trend,and from 2016 to 2017,it began to decline back to the same level as that in2013.Overall,the average hospitalization cost per time in tertiary hospitals was the highest,and the composition ratio of drug cost was the highest.The average ratio of total hospitalization expenses and individual out-of-pocket expenses to per capita disposable income of gastric cancer participants were 1.24 and 0.5,respectively,indicating that the disease burden was still very heavy.(2)A total of 229 hospitalized medical records of gastric cancer patients from 2019 to 2020 were recorded,including 174 males and 55 females.The mean age was 65.2±10.9 years.In terms of hospitalization,more than 96%of the patients underwent routine blood and blood biochemical tests,and 72.05% of the patients underwent endoscopic examination(mainly gastroscopy),and 69.87%underwent CT examination,compared with 21.4% of the patients undergoing angiography.The proportion of patients receiving surgery,radiotherapy and chemotherapy was 57.21%,4.8% and 44.54%,respectively.(3)A total of 688 subjects were included in the case-control study on factors affecting gastric cancer,including172 patients with gastric cancer in the case group and 516 ordinary residents in the control group.The mean age of the patient group and the control group was 66.16±9.6years and 64.83±9.12 years,respectively.The males accounted for 77.9% in the case group and 73.4% in the control group.132 patients in the case group lived in rural areas for a long time,accounting for 76.7%;The proportion of the control group who lived in rural areas for a long time was 73.6%.Multivariate Logistic regression analysis showed that frequent stomach discomfort,frequent consumption of preserved food,excessive eating speed,frequent smoking and tea drinking,long-term exposure to pesticides,livestock and pets,and sulking were independent risk factors for gastric cancer while experienced significant weight change,eating seafood regularly and drinking well water for a long time were independent protective factors.(3)Qualitative interview results showed that 75% of the patients thought it was OK after discovering physical abnormalities,and 50% of the patients did not go to the doctor until more than one month after discovering abnormalities.Less than 10% of the patients paid attention to their physical changes,and 58.3% of the patients did not have the habit of regular physical examination.20.8% of patients would first seek acquaintances no matter what their physical conditions were,and 33.3% would go directly to a large hospital to see a doctor no matter whether the condition was serious or not.In terms of lifestyle changes,no one bought health care products on the market,10 people drank regularly before diagnosis and quit now,and only 4 of 10 people who smoked regularly before illness quit smoking.Only three of them exercise regularly.In terms of mental mood,29.17% of the patients felt worried or afraid because of health or disease in the last two weeks,25% of them were depressed or sad,and 33.3% had sleep problems.(4)Based on the above results,the coping deficits of patients with gastric cancer were divided into five types: "lack of prevention and treatment knowledge","less than assessment / redesign","extreme coping strategies","giving up health care / diagnosis and treatment" and "persistent anxiety / depression".The corresponding design is divided into six target behavior as improve nutrition diet,maintain good behavior habits,pay attention to physical changes,seek medical treatment scientifically,cooperate to participate in diagnosis and treatment,keep good psychological mood,accordingly to develop a preliminary scheme of remote psychological behavior intervention gastric cancer patients.Conclusion(1)The medical cost of gastric cancer inpatients is high,and more patients tend to seek medical treatment in the tertiary hospital.The patients’ families and health system bear a huge burden.Therefore,in the intervention of patients with gastric cancer,we should add some propaganda and education knowledge,including hierarchical diagnosis and treatment system,serious illness subsidy policies,and help patients reduce the pressure in health resources,disease economic burden and other aspects.(2)The influencing factors of gastric cancer are many and complex,involving the physiological and psychological aspects of patients.We need to comprehensively consider a variety of risk factors and protective factors to implement intervention for patients with gastric cancer.(3)When facing the disease,the patients with gastric cancer have some defects in symptom discovery and self-evaluation,and the awareness of risk and self-care is not strong which shoud be taken considered into targeted intervention designing.(4)In this study,based on the health belief model and artificial intelligence technology,a set of feasible psychological behavior remote intervention program for gastric cancer patients was developed,and personalized intervention was implemented for the intervention objects from multiple ways by integrating various conditions of the intervention objects. |
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