| Objective:The study was aim to investigate the adherence of community multimorbidity patients and explore the influencing factors.In order to analyze the model of selfmanagement group based on family doctor's contract service to improve the physical and physiological indexes of multimorbidity patients,improve the adherence,emotional function and mental health among the patients,reduce the burden of treatment and the evaluation effect on the signing service of the family doctors.Methods:This research is mainly divided into two parts: current situation investigation and experimental research.Nine hundred and seven patients in Lecong Community Health Service Center in Shunde District of Foshan from May and Auguest 2016 were selected by using random sampling method.We investigated its social-demography date and related information of disease.The Chinese version of the 8-item Morisky Medication Adherence(MMAS-8)was used to investigate the medication adherence,the overall health items of SF-36 scale was adopted to assess the selfassessed health status.And the the factors associated with multimorbidity in the participants were analyzed.Then according to the principle of territorial management,five sites were divided into intervention group and control group,including 456 cases in intervention group and 451 cases in control group.The patients in the control group were routinely intervened according to the contract service agreement of the family doctor.The patients in the intervention group carried out the self-management group activities on the basis of the family doctor's contract service.Group activities are conducted in the form of seminars,mainly consisting of interaction between lectures and discussions.The leader of the group is a family doctor.The leader of the group is trained in theory and operation of the patients in accordance with the teaching plan.The members of the group learn from each other and supervise each other by sharing their experience and experience in the prevention and control of their disease.Each patient participated in activities less than 4 times a year.One year after intervention,the adherence of the two groups,the burden of treatment,the emotional and mental health scores under the quality of life,self-assessed health status,the way of life behavior,and the evaluation effect on the signing service of the family doctors were compared.The changes of systolic pressure(SBP),diastolic pressure(DBP),fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),Serum creatinine(SCr),blood urea nitrogen(BUN)and serum uric acid(UA),body mass index(BMI),waist circumference(WC),hip circumference(HC)and pulse(P)in two groups of patients were observed.The data of this study are built by Epidata 3.0,and SPSS 16.0 software is used for statistical analysis.The counting data is expressed by percentage(%),and the measurement data is expressed by(±S),the Chi-square test of R*C table and the independent sample t test were used for statistical analysis.The influencing factors of adherence in multimorbidity patients were analyzed by Logistic regression model analysis.The nominal level of significance for the statistical analysis was set at P<0.05 for a two-tailed test.Results: 1.Medication adherence and influencing factors of community multimorbidity patients.The average MMAS-8 score was(6.4±1.7).495 cases(54.6%)got more than 6 points,412 cases(45.4%)less than or equal to 6.There was no significant differences in medication adherence among the patients with different gender,age,marital status,living condition,education level,BMI,and the medication duration,drinking,regular exercise(P>0.05);There were significant differencs in medication adherence among the patients with different medical payment methods,working situation,household monthly income per person,numbers of comorbidities,medication types,selfassessed health status,smoking,balanced diet,self health care(P<0.05).Multivariate Logistic regression analysis found that medication adherence was affected substantially by medical payment methods [OR=1.384,95%CI(1.161,1.649)],working situation [OR=0.463,95%CI(0.324,0.661)],numbers of comorbidities [OR=1.771,95%CI(1.467,2.137)],self-assessed health status [OR=1.980,95%CI(1.517,2.583)] and balanced diet [OR=1.833,95%CI(1.213,2.771)].2.The effect of self-management group on community multimorbidity patients.2.1 There was no significant differences in the demographic characteristics,disease related data and sub distribution of patients with major diseases between the two groups(P>0.05).2.2 After one year of intervention,there were significant differences in systolic pressure,diastolic blood pressure and serum creatinine(P<0.05).There were no significant differences in other indexes(BMI),pulse,fasting blood glucose,total cholesterol,triglyceride,blood urea nitrogen and blood uric acid(P>0.05).2.3 After one year,the average MMAS-8 score of the patients in the intervention group was(7.62±0.93),which was higher than that of the control group(7.32±1.08).The treatment burden score of the intervention group was(33.65±19.18),which was lower than that of the control group(48.33±15.56),the intervention group of emotional function score was(93.64±20.70),higher than that of the control group(88.47±25.49),and the mental health score intervention group was(69.84±11.49),higher than that of the control group(68.13±8.83),the difference between the two groups was statistically significant(P<0.05).2.4 After one year,the two groups of patients were compared to their own health evaluation.187 cases(41.5%)were well evaluated in the intervention group,and 111 cases(24.8%)in the control group,the difference between the two groups was statistically significant(P<0.05).In the way of living and behavior,33 cases(7.3%)were smoking in the intervention group and 51 cases(11.4%)in the control group,the number of regular exercise in the intervention group was 263 cases(58.3%)and 233 cases(52%)in the control group.The difference between the two groups was statistically significant(P<0.05).The number of alcohol consumption in intervention group was 71 cases(15.7%),compared with 53 cases(11.8%)in control group,the difference was not statistically significant(P>0.05).2.5 After one year,two groups were compared to evaluate the effect of family doctor's contract service on disease prevention and treatment,reducing medical expenses and improving medical convenience.The positive rate of the patients in the intervention group was higher than that of the control group,and the difference was statistically significant between the two groups(P< 0.05).Conclusions: 1.The medication adherence of community multimorbidity patients is not high,and needs further improvement.The main factors affecting the medication adherence of the patients are the medical payment methods,working situation,numbers of comorbidities,self-assessed health status,unbalanced diet under self management behavior,and the intervention and management should be be carried out according to its influencing factors and characteristics.2.Self management group activities can change the unhealthy lifestyles and behaviors of multimorbidity patients,improve their self-assessed health and medication adherence,improve the self emotion management ability,help mental health,and reduce the burden of disease treatment for patients,can improve patient's sense of identity and sense of acquisition for family doctor's contract service.3.Self management group activities are the extension and deepening of the connotation of family doctor contract service,and it is worth further promoting in the community. |
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