| The paper is composed of literature review and clinical research.Literature reviewWestern medicine literature of chronic obstructive pulmonary disease research status of Integrated Management (COPD for short) conducted review, Chinese literature, Tradition Chinese medicine for chronic way of integrated management are reviewed.Clinical researchObjectiveThrough the Chaoyang District and Fengtai District Community Health Service Management COPD stable cyclic (Third hospitals-Community Health Service-Family health worker/patient to participate in the management of COPD ring) and analytical results comparison of the model to explore the effectiveness, feasibility, and proposed improvement measures at the shortcomings of the model.MethodsIn Chaoyang District and Fengtai District getting 230 cases in line with the diagnostic criteria for chronic obstructive pulmonary disease and the subject inclusion criteria patients were randomly divided into cluster management and control groups, Fengtai District, into the final group of 230 cases, four cases of loss, excluding 26 cases of patients with complete data, 102 cases of the management group, the control group 98 cases,61 cases into the Chaoyang District, shedding three cases, patients with complete data, the management group of 32 patients in the control group of 26 patients. File management group established COPD, health education, exercise, medication guidance, psychological counseling and other aspects of all-round multi-level intervention; the control group only basic information registration and drug treatment guidelines, and without other interventions. OUTCOME MEASURES:Before patient management statistics basic information, including age, medical history, smoking history, the average annual household income last year, chronic obstructive pulmonary disease treatment costs, etc; are before management spirometry, management and quality of life scores after 12 months (CAT score), the degree of difficulty breathing (mMRC), symptom rating scale, the number of acute attacks, hospitalization and assessment of the number of statistics. Using statistical methods for basic information, between groups within the set of data for analysis and comparative evaluation.Results1.In the cases included in the side, into the same group two city intends number of cases, were 230 cases, the management group and the control group of 115 cases, a total of Fengtai District, into the final group of 230 cases, four cases of loss, excluding 26 cases to the management end when complete data cases total 200 cases, the management group 102 cases in the control group 98 cases; Chaoyang District, a total of the 61 cases, shedding three cases, with complete data cases 58 cases, the management group of 32 cases,26 cases in the control group until the end of management time. Two were included in the city and in the presence of an integrated management is a huge difference, Fengtai District, substantially completed the expected goal, Chaoyang District, far from the intended target.2. In the two basic statistical information found in urban areas, into the group with an average history of Chaoyang District,13.34 years, Fengtai District 15.46 years last year, accounting for 11.08% of the total cost of COPD household income percentage Chaoyang, Fengtai District 13.65%.3. In terms of outcome measures, due to less number of cases, Chaoyang District, baseline data is not balanced, it is only in the comparison group, declined before Chaoyang District Management Group CAT score, mMRC grade, grading scales and other symptoms than those in administration, the difference was statistically significant; exacerbations> 2 times the proportion decreased, the difference was statistically significant. Improved lung function compared with the previous management group, the difference was statistically significant. Fengtai District baseline equilibrium, CAT score, mMRC grade, grading scales and other symptoms than those in administration before the decline, compared with the control group, the difference was statistically significant; exacerbations> significantly reduced the ratio of 2 times compared with the control group, the difference was statistically significant. Management group no significant improvement in lung function indices, and between the control group was not statistically significant group differences.Conclusion1. The two urban incidence, the number of people aged over 40, the number of the number of target group and take on the role of community health agencies are substantially equal, Fengtai District Community Health Service in COPD patients were included in the target rate of 100%, which when complete data integrity issues rate was 86.9%, substantially complete the desired objectives; Chaoyang District community health service in COPD patients were included in the target rate was 26.52%, when the subject is completed with complete data rate 25.22%. There is a community of poor management, poor patient with defects in the concrete implementation of the integrated management of the process, the need to further improve and perfect the model.2. The two districts enrolled patient's basic information statistics show that COPD patients brought a heavy burden on quality of life and economic burden of COPD integrated management is necessary.3. The terms of indicators observed after 12 months of "three hospitats - community health services-home health worker/patient to participate in the management of COPD ring" quality of life of two groups of community management score, dyspnea, symptoms classification to quantify the number of exacerbations were improved, Chaoyang District, before the management group compared with lung function improved management, but the small number of cases, do not have to promote the significance. Fengtai District Management Group not improve lung function. Proof ring management in improving the quality of life scores, dyspnea, symptom ratings to quantify the number of exacerbations and so has a certain role, reflecting the effectiveness of the management model. |
PDF Full Text Request