The Effects Of Self-management Intervention On Patients With Stages ?-? Chronic Kidney Disease

Objective To explore the effect of self-management intervention on self-management behavior,medication adherence and disease outcome(nutrition,blood pressure,renal function,hospitalizations)in chronic kidney disease.Methods 1.160 patients with chronic kidney disease were enrolled in a top three hospital from November 2015 to June 2016.Two groups were randomly assigned to control group(n=80)and intervention group(n=80).Patients fromthe control group were given routinecare,including health assessment,health education,telephone follow-up and so on.Patients in the intervention group received self-management intervention at the same time as receiving routine care.Firstly,we collect,analysis and plan by patients' information,telephone,We-Chat and outpatient intervention with 6 months after discharge.2.The patients' demographic and disease related data were collected by the general questionnaire.Chronic Kidney Disease Self-management Scale,Chronic Disease Self-efficacy Scale,Morisky Medication Adherence Scale and SGA were assessed upon baseline.Data was collected on the 3rd month and the 6th month after dischargedincluding self-managementbehavior,medication adherence,nutrition and clinical index.3.Data was analyzed by SPSS21.0.The mean ± standard deviation,median range interquartile,frequency and percentage for data statistical description.Using Chi-square test,Kruskal-Wallis non-parametric testand the two dependent sample T test compare with the two groups.The changes in 2 groups during 3 times were analyzed by repeated measurement of variance analysis.Result 1.The general demographic data and disease-related date were no significant differences between the two groups(P>0.05).2.The results of repeated-measures analysis of variance indicated that the intervention group had shown a better recovery inself-management behavior than the control group(P<0.05).Intervention group and control group patients' self-management behavior scores were improved significantly(F=51.531/12.775/16.995/21.339/32.215,P<0.001).Different points in time,patients' self-management behavior scores were improved significantly(F=118.554/37.276/32.394/23.252/45.150,P<0.001).Group effect and time effect have interaction(F=50.916/11.088/14.940/18.840/18.301,P<0.001).3.The results of repeated-measures analysis of variance indicated that intervention group and control group patients' medication adherence scores were improved significantly(F=18.869,P<0.001).Different points in time,patients' medication adherence scores were improved significantly(F=20.065,P<0.001).Group effect and time effect have interaction(F=7.919,P<0.001).4.The SGA and blood pressureof the two groups were not statistically significant before discharged from hospital(?2=0.056,P=0.813;?2=0.069,P=0.793).The SGA,blood pressure andhospitalizationsof the two groups were not statistically significant on the 3rd month after discharged(?2=1.146,P=0.284;?2=1.189,P=0.275;?2=0.344,P=0.558).The SGA,blood pressure of the two groups were statistically significant(?2=4.608,P=0.032;?2=4.231,P=0.040)and hospitalizations was not statistically significant on the 6th month after discharged(?2=1.764,P=0.184).5.The results indicated that the Hemoglobin(Hb),Albumin(Alb),Serum Creatinine(Scr)and Glomerular Filtration Rate(GFR)of the two groups were not statistically significanton the 3rd month after discharged(t=1.035,P=0.302;t=1.106,P=0.270;Z=-0.294,P=0.769;Z=-0.861,P=0.389).The Hb,Alb and GFR of the two groups were statistically significant(t=2.012,P=0.046;t=2.317,P=0.022;Z=-1.969,P=0.049)and Scr was not statistically significant on the 6th month after discharged(Z=-0.472,P=0.637).Conclusion Self-managementintervention is an effective intervention style.It can improve self-management behavior,medication adherence and disease outcome(nutrition,blood pressure,renal function).It is suitable for promotion in clinical care.