| ObjectiveTo evaluate the case management model for Continuous Ambulatory PeritonealDialysis (CAPD) patients on the hospitalized patients’satisfaction, biochemicalvalues, quality of life and influence of peritonitis rates so as to explore the CAPDpatients management mode and provide the clinical reference basis for the effectivechronic disease management model for hospital.MethodsThis was a randomized and prospective study. From July2012to March2013,80CAPD patients extracted conveniently from the peritoneal dialysis treatment centerof Shaoyang central hospital in Shaoyang city were randomly divided into two groupssuch as the experimental group(n=40）and the control group(n=40). The patients ofexperimental group were cared by a case management model during hospitalizationand follow-up after6months of discharge while the patients of control group werecared by the common care management. The case management was a kind of workingprocedures including assessment, planning, implementation, coordination, supervisionand evaluation.Subjects were investigated with the general condition questionnaireand the patient’s satisfaction questionnaire in two days after their admission; Subjectswere investigated with the patient’s satisfaction questionnaire in the day beforedischarge again; the KDQOL-SFTMscale and clinical biochemical values such as thepotassium, hemoglobin, albumin, blood creatinine, blood scales, calcium and iPTH,etc were tested before, after3months and6months intervention; the peritonitis ratesof two groups were tested after3months and6months intervention. The collecteddata were analyzed by the statistical software SPSSl3.0and the statistical methodsincluded statistical description, t-test, chi-square test, profile analysis, repetitivemeasures ANOVA and so on. Results1. Baseline comparison before interventionIn the control group, the score of hospital patient satisfaction was81.30±6.01; themean score of quality of life SF-36was46.83±11.36, KDTA was58.42±9.02;clinical biochemical values were followed as RBC was2.68±0.56l×1012/L, Hb was76.73±14.52g/l, Alb was35.11±4.04g/l, K+was4.16±0.62mmol/l, Ca2+was2.03±0.31mmol/l, P3+was1.87±0.43umol/l, creatinine was551.89±212.23mg/dL, iPTHwas534.94±267.08pg/ml. In the experimental group, the score of hospital patientsatisfaction was82.59±5.97;the mean score of quality of life SF-36was47.27±10.95,KDTA was58.71±8.08; clinical biochemical values were followed as RBC was2.62±0.44×1012/L, Hb was75.38±11.42g/l,Alb was35.31±4.89g/l, K+was4.29±0.68mmol/l, Ca2+was2.07±0.23mmol/l, P3+was1.77±1.77umol/l, creatinine was562.28±221.85mg/dL, iPTH was566.28±247.78pg/ml. There were no statisticallysignificant difference(P>0.05) for the data in two groups patients.2. Comparasion of intra-group after the intervention2.1After2weeks intervention, the score of hospital patient satisfaction in the controlgroup (84.93±6.46) was higher than that of before, the difference was statisticallysignificant(P<0.05); the score of hospital patient satisfaction in the experimentalgroup was higher(92.32±7.70) than that of before, the difference was statisticallysignificant(P<0.05).2.2In the control group, the mean score of quality of life SF-36(51.87±9.99) andKDTA(60.51±7.19) were higher than those of before, but there was no statisticallysignificant difference(P>0.05); clinical biochemical values were followed as RBC(3.11±0.47mm), Hb(91.40±10.86), P3+(2.11±0.29) were better than those of before,the difference was statistically significant (P<0.05); Alb(35.57±4.66), K+(3.98±0.56),Ca2+(2.16±0.44), creatinine(502.53±258.36), iPTH(470.95±215.31) were better thanthose of before, but there was no statistically significant difference(P>0.05) after3months intervention. The mean score of quality of life SF-36(52.77±7.98) and KDTA(58.99±9.42) compared with those of3months intervention, there was no statistically significant difference (P>0.05); clinical biochemical values followed as only P3+(1.84±0.49) was better than those of3months intervention, the difference wasstatistically significant (P<0.05);RBC (3.30±0.48), Hb (92.40±9.91) and Alb(33.47±5.74), K+(3.94±0.49), Ca2+(2.18±0.29), creatinine (449.90±197.22), iPTH(464.20±233.65) compared with those of3months intervention, there was nostatistically significant difference (P>0.05) after6months intervention.2.3In the experimental group, the mean score of quality of life SF-36(59.38±8.31) andKDTA (66.22±7.27) were higher than those of before, the difference was statisticallysignificant (P<0.05); clinical biochemical values were followed as RBC (3.33±0.54),Hb(99.00±10.16), K+(3.75±0.58), P3+(2.27±0.20), Ca2+(2.25±0.21), creatinine(460.62±199.59)were better than those of before, the difference was statisticallysignificant (P <0.05); Alb (38.02±4.55), iPTH (505.98±253.95)were better than thoseof before, but there was no statistically significant difference(P>0.05) after3monthsintervention. The mean score of quality of life SF-36(59.38±8.31) and KDTA(64.12±7.97) compared with those of3months intervention, there was no statisticallysignificant difference (P>0.05); biochemical values were followed as RBC (3.64±0.49mm), Hb (98.32±9.79), P3+(1.69±0.49)were better than those of3months intervention,the difference was statistically significant (P<0.05); Alb (37.22±5.73), K+(3.64±0.41),Ca2+(2.17±0.21), creatinine (413.89±160.60), iPTH (442.73±202.14) were better thanthose of3months intervention, but there was no statistically significant difference (P>0.05) after6months intervention.3. Comparasion of inter-group after the intervention3.1After the intervention, the score of hospital patient satisfaction in the experimentalgroup (92.32±7.70) was higher than the control group (84.93±6.46), the differencewas statistically significant (P<0.05).3.2After3months intervention, the mean score of quality of life SF-36and KDTA werehigher than those of the control group, the difference was statistically significant(P<0.05); clinical biochemical values were followed as RBC, Hb,Alb, P3+were betterthan those of the control group, the difference was statistically significant (P<0.05); K+, Ca2+, creatinine, iPTH compared with the control group, there was no statisticallysignificant difference(P>0.05); peritonitis rates (3.2%) was lower than that of thecontrol group (6.7%), but there was no statistically significant difference (P>0.05).3.3After6months intervention,the mean score of quality of life SF-36and KDTA werehigher than the control group, the difference was statistically significant (P<0.05);clinical biochemical values were followed as RBC, Hb, Alb, K+, Ca2+were better thanthe control group, the difference was statistically significant (P<0.05); P3+, creatinine,iPTH compared with control group, there was no statistically significant difference(P>0.05);peritonitis rates (9.7%) was lower than that of the control group (16.7%), butthere was no statistically significant difference (P>0.05).conclusion(1)The case management may improve the satisfaction of hospitalized CAPD patients.(2) The case management do effectively in CAPD patients’s some biochemical value.(3)The case management may improve the quality of life for the CAPD patient. |
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