Effect Of Integrated Ward-Outpatient-Family Health Care Management On Negative Emotion And Self-Nursing Ability In Patients With Chronic Kidney Disease

Objective: Chronic kidney disease(CKD),one of the chronic non-communicable diseases with high incidence in the world,has become a major social and public problem.CKD is characterized by long-term chronic spiral progression,and with the progression of the CKD stage,the degree of anxiety,depression,and insomnia are gradually aggravated.Therefore,patients with CKD need not only refined management but also long-term outpatient follow-up and family management.during hospitalization.This study aimed to explore the effect of integrated ward-outpatient-family health care management on anxiety,depression,sleep quality,self-care ability and some biochemical indexes in patients with CKD.Methods: In this study,310 CKD patients who met the inclusion and exclusion criteria were recruited and were admitted to the Department of Nephropathy of the first affiliated Hospital of Anhui Medical University from July 2019 to November 2020.A total of 310 patients were randomly divided into control group and intervention group with 155 patients in each group according to the time of admission.The patients in the control group were given routine CKD nursing measures.Beside the routine nursing,patients in the intervention group received integrated management of ward-outpatient-family medical care.The patients in the two groups were both investigated with general characteristics questionnaire,serum uric acid,c-reactive protein,serum creatinine and fasting blood glucose.The patients also underwent baseline surveys including self-rating anxiety scale(SAS),self-rating depression scale(SDS),Pittsburgh sleeps quality index scale(PSQI)and exercise of self-care agency scale(ESCA)questionnaires.Based on these surveys,the level of anxiety,depression,sleep quality and self-care quality was evaluated in intervention group.Besides,if necessary timely psychological counseling and health education were provided during the 6-month follow-up period.Six months after discharge,follow-up assessment was applied.SAS,SDS,PSQI and ESCA questionnaire were assessed,as well as those biochemical indicators.A database was set up on account of the information collected.The statistical analysis was conducted by SPSS 23.0 software.Results: In this study,28 patients were withdrawal(experimental group:12;control group: 16),with a loss rate of 9%.A total of 282 participants completed the study and obtained intact data.There were 143 patients(male 57,39.9%)in the intervention group and 139 cases(male 62,44.6%)in the control group.Before the intervention,the scores and internal distribution levels of SAS,SDS,PSQI,and ESCA between the intervention and control groups were consistent(all P>0.05).After 6 months of intervention,the total score of anxiety,depression,and sleep quality in the intervention group were markedly lower than those in the control group.The total score of self-nursing ability in the experimental group was ascending compared with the control group.At the level of internal distribution,after intervention the level of anxiety and depression in intervention group was significantly decreased,and sleep quality and self-care ability were significantly improved.After intervention,SAS(36.12±11.64),SDS(48.25±13.03),and PSQI(9.61±4.62)scores were significantly lower in the control group than those in the intervention group SAS(44.31±10.15),SDS(51.55±13.13),PSQI(11.17±3.70)(p <0.01).Additionally,the ESCA score was considerably higher in the intervention group(39.53±22.56)than in the control group(132.76±22.61)(P<0.01).After intervention,the level of serum uric acid(362.32±259.79 umol/L)and c-reactive protein(6.02±8.25 mg/L)was significantly lower in intervention group than serum uric acid(465.12±372.00 umol/L)and c-reactive protein(8.76±10.32 mg/L)in control group(p<0.05).Conclusions: The integrated management of ward-outpatient-family health care for CKD patients can reduce the degree of anxiety,depression,improve the sleep quality and self-care ability,as well as improve the level of serum uric acid and Inflammatory biomarker.This management mode is expected to improve patients’ quality of life,which is suitable for clinical application.