| BackgroundAs one of the three "killers" of people health, stroke is one of the most common diseases, which has high morbidity, motility and disability rate. 50%～70% survivors have paralysis, aphasia and other deformities, which greatly destroy patients' daily life, bring heavy burden to the society and patients' families. With global aging process speeding up, more and more elders need family and social care, especially the elderly with chronic disease. The senilities and physical disabilities elderly would become the groups of high demand of family care and long-term nursing care, whereas nowadays there has no integrated care system in china. Therefore, the study on evaluating long-term care demands and influencing factors, the research aiming at rural areas which has a unsubstantial care system in particular, has practical significance in finding out the burden brought by country patients, and putting forward interventions on influencing factors to satisfy the sufferers' demands.At present, most domestic and foreign researches are qualitative, and the Chinese scholars give less attention to the family care demands of patients in rural areas. Moreover, the reports about the evaluating of the elders' care acquisition and the care economic burden haven't been retrieved. Our study evaluated the sufferers' care demands comprehensively, and surveyed the stroke patients' care acquisition measured in period of time. The care economic burden was calculated based on the caregivers' payment standard per hour. This study analyzed the patients' long-term care satisfaction and the related reasons, found out the main factors affecting the care demands and care acquisitions, brought forward policy recommendations to reduce family members' care burden, and satisfy the patients' need.Research purposeThis study was designed by research purpose to access the care demands and care acquisitions of stroke patients in rural areas of Shandong province through self-designed questionnaire, and to ascertain the main influencing factors. The effective measures and policy recommendations aimed at influencing factors were given to improve the care quality of stroke patients in rural areas.Objectives:1) Find out and survey the care demands and care acquisitions of stroke patients in rural areas of Shandong province, institute the quantity standard of care need;2) Analyze and ascertain the influencing factors of stroke patients' care demands and care acquisitions;3)Calculate the sufferers' average care hours in one year and the care economic burdens, assess the social impact;4) Make recommendations on existent problems to improve the care quality of stroke patients in rural areas.MethodIn this study we use both quantitative research and qualitative research methods. According to the economic status and geographical position of different areas in Shandong Province, The study selected Laiyang and Gaotang County as study sites, and all the villages and towns were divided into two stratum, selected 3-4 townships in each stratum and selected 5-6 villages in each township through random sample method. The sample was taken from every village, all the stroke patients in the selected village were surveyed. The care demands and care acquisitions, the socio-demographic characteristics, the activities of daily life, the Fugl-meyer motor function, and the general information about the sickness, therapy, prevention, health care, family function and social support of the stroke patients were investigated by self-designed questionnaire. The study collected qualitative information through in-depth interviews using purpositive samples, such as typical stroke patients, family caregivers and rural doctors. The main issues included: 1) patients: the satisfaction degree of care; the unsatisfied aspects; the expectation of care etc. 2) Family caregivers: their care enthusiasm and intimate relationship with patients; the care burden; the existent troubles etc; 3) rural doctors: the influencing factors of care demands and care acquisitions, the steps to reduce care burden and improve care quality.The in-depth interviews also carried out among the administrators and care workers of elderly apartment and the experts in the related field to get a comprehensive understanding of the social care resources provided by government, find out the existent problem and the breakthrough of establishing care system.ResultsAfter the analysis of collected data, it is found that 85% of the stroke patients need family care, the average point of total care demand is 68.98, which indicates a general grade. The five highest care demand items are washing clothes, cooking, supporting and understanding from family, buying grocery and swabbing down. The chief care demand items of patients with activity of daily life being low or middling, are cooking and washing, and that of patients with activity of daily life being high, are supporting and understanding from family and guiding of disease knowledge. The average time of total care acquisitions is 6.87 hours/day, namely 313 working-days/year, the maximum care acquisition items of patients are cooking, taking food, chatting, washing and getting out of bed to walk. Cooking, washing and chatting are the maximum care acquisitions items, in spite of the patients' activity of daily life. In term of care standards, the patients basically being able to self care need 5.6 hours/day care (260 working-days/year care), the patients partly being able to care themselves need 8.5 hours/day care (390 working-days/year care), and the patients entirely being unable to care themselves need 11.2 hours/day (510 working-days/year care). The average care time of all the patients is 386 working-days/year. The average care economic burden of investigated objects in Laiyang is￥22,100/year, that of investigated objects in Gaotang is￥16,800/year, and that of stroke patients in rural areas of these two counties is￥18,000 /year.The influencing factors of care demands and care acquisitions are as follows:1) The influencing factors of total care demands include: ADL (Activity of daily life), Limb movement function, Property supporting by child, Disposable potency of family property, Health situation of patient's spouse, Community support.2) The influencing factors of basic life care demands include: ADL, Limb movement function, Course of diseases, Recurrence times, Main symptoms, Timely treatment or not, Adequacy degree of treatment, Frequency of exercise, Filial degree of children.3) The influencing factors of basic living care demands include: Education, ADL, Limb movement function, Main symptoms, Complication, Adequacy degree of treatment, Frequency of exercise, Eminent domain of family property, Number of sons, Whether spouse be the main caregiver, Health situation of patient's spouse, Community support.4) The influencing factors of medical care demands include: Gender, ADL, Main symptoms, Complication, The highest education of caregiver.5) The influencing factors of health education and psychological care demands include: Age, Proportion of medical claim, Limb movement function, stroke type, Main symptoms, Complication, Timely treatment or not, Frequency of exercise, Health situation of patient's spouse, The highest education of caregiver, Community support.6) The influencing factors of total care acquisitions include: Age, vocation, Proportion of medical claim, ADL, Limb movement function, Recurrence times, Complication, Timely treatment or not, Frequency of exercise, Health situation of patient's spouse.7) The influencing factors of basic life care acquisitions include: Age, Vocation, Proportion of medical claim, ADL, Limb movement function, Recurrence times, Complication, Timely treatment or not, Frequency of exercise, Filial degree of children, Health situation of patient's spouse, Community support. 8) The influencing factors of basic living care acquisitions include: Gender, Proportion of medical claim, Limb movement function, Course of diseases, Concomitant symptom, Complication, Frequency of exercise, Eminent domain of family property, Filial degree of children, The highest education of caregiver.9) The influencing factors of medical care acquisitions include: Education, Limb movement function, Main symptoms, Concomitant symptom, Complication, Frequency of exercise, Eminent domain of family property, Property supporting by child.Conclusion and SuggestionsThe care needs of stroke patients in rural areas of Shandong province are high, the care demands of that are not very high, and the care acquisitions of that are low. The study use the phrase "the good get better, and the bad get worse" to describe the sufferers' satisfy situation of care demands, that is to say, the more satisfied with the care, the more care patients will get, and the less satisfied with the care, the less care patients will get. It's a serious phenomenon that passive treatment and negative care is ubiquitous. It's the essential ability influence the care demands and care acquisitions that the health situation of patients, and the diseases and symptoms and their prevention influence the demands and acquisitions as intrinsic factors. The family function and community support directly act on them, and Socio-demographic characteristics influence them as external features.At present, it's not ready for our country to develop a great deal social care centers, the right way may be providing assistance to family care, community supporting, encouraging and intervening family came, and supervising the care implementing and carrying out medical check-ups through the village doctors' regular visits. The study overviewed 4 aspects of policy to initiate work:1) Strengthen health education, development three steps of rehabilitation, the enhance patients' ability.2) Support and concern socially, care and consider by family, improve the mental health of patients.3) Increase government's investment, constitute comprehensive policy, establish and improve care system.4) Develop community care, perfect family care, Explore new care models.
|
PDF Full Text Request