The Influence Of Transitional Care On Self-management Ability And Health Outcomes Of Patients With Percutaneous Coronary Intervention

ObjectiveTo explore the the status quo and relationship between self-management ability,posttraumatic growth,anxiety,depression,quality of life in patients with Percutaneous Coronary Invervention(PCI).Through randomized controlled clinical trials to explore the effect of transitional care model to the PCI patients'self-management behaviour and health outcome.So that we can add chronic management theory and improve the health outcome,and provide theoretical and empirical evidence of targeting interventions for medicalworks.Methods1.A total of 388 patients with percutaneous coronary intervention in one tertiary grade-A hospital in Taian city were investigated with cross-sectional survey by using Coronary artery disease Self-management Scale(CSMA),Hospitals Anxiety and Depression Scale(HADS),Posttraumatic Growth Inventory(PTGI),Seattle Angina Questionnaire(SAQ),to test the self-management ability,anxiety,depression,posttraumatic growth,quality of life and so on.Data were processed using SPSS(Statistical Package for the Social Sciences)17.0 software.Pearson correlation techniques were used to examine the relationship between quality of life,self-management behavior,posttraumatic growth,anxiety and depression2.134 inpatients from one tertiary grade-A hospital were recruited for study.Participants were divided into experimental group and control group by random,Totally six patients were excluded for losting follow up,At the end,there are 66 patients for control group and 68 patients for experimental group..They were both assessed on the self-management behaviour,depress,anxiety,posttraumatic growth,quality of life,Total Cholesterol(TC),Fasting Blood-glucose(FB),weight,Body Mass Index(BMI),Triglyceride(TG),High Density Lipoprotein(HDL),Low Density Lipoprotein(LDL),Interleukin 6(IF-6),Tumor Necrosis Factor?(TNF-?)and so on.before discharge,After discharge,patients of experimental group were given individualized health education on telephone.The basic information from the patients in two groups were gathered on admission,after 1 month,3 months and 6 months,related materials were gathered again and comparatively analyzed.SPSS 17.0 statistical software was used for descriptive analysis,chi-square test,t test,repeated measures,stepwise multiple regression analysis,hierarchical regression analysis etc.P<0.05 was statistically significant.Results1.Quantitative research results:Firstly,the total score of self-management behaviour in patients with percutaneous coronary intervention was 70.82±11.83;The total score of depress and anxiety was 17.45±5.71,anxiety was 8.61±3.67,depress was 8.84±2.54;The total score of posttraumatic growth was 59.24±8.16;The total score of quality of life was59.48±13.99.Secondly,patients'self-management behaviour was positive correlated with the quality of life(r=0.878,P<0.01)and posttraumatic growth(r=0.374,P<0.01);CSMS of PCI patients was negative correlation with depress,anxiety(r=-0.401,P<0.01).Thirdly,education level,depress and angina frequency can significantly predict the level of self-management,all the variables could explain 79.0%(R~2=28.4,P<0.01)of the self-management ability,among them education level and angina frequency were positively predict the level of self-management ability,while depress could negatively predict the level of self-management ability.Fourthly,All the variables could explain71.9%of the variance of quality of life.Variables of demography and disease characteristic accounted for 15.0%of the variance of quality of life.Additionally variables of PTG explained an additional 13.6%of the variance of quality of life,depress and anxiety explained an additional 9.2%of the variance of quality of life,while variables of self-management ability explained an additional 41.6%of the variance of quality of life.2.Totally six patients were excluded for losting follow up,there are 66 patients for control group and 68 patients for experimental group.Before the intervention,there were no significant differences between the intervention groups and the control group in the scores of the studying variables.Both experimental group and control group in diffent time points of at discharge,3 months after hospital discharge and 6 months after hospital discharge within the same group data was analysed by repeated measures analysis of variance showed that:PCI patients'level of self-management ability(time effect F=104.551,P<0.01),level of posttraumatic growth(time effect F=95.702,P<0.01)and quality of life(time effect F=44.661,P<0.01)were all gradually increased along with the extension of time after discharge in intervention groups and the control group.After intervention by transitional Care models:Firstly,Repeated measures analysis of variance showed that the transitional care intervention for the“treatment satisfaction”score has significant effects(group effects F=6.465,P<0.01).Independent-sample t-test showed that at six months after the end of the intervention,The“treatment satisfaction”scores has significant increased in the intervention group compared with control group(P<0.01).Secondly,Repeated measures analysis of variance showed that the transitional care intervention and for the PTGI total score has significant enhanced(group effects F=13.756,P<0.01).Independent-sample t-test showed that at three months after the end of the intervention,The PTGI scores has significant higher in transitional care group than in control group(P<0.01);at six months after the end of the intervention,the intervention's effects on the"spiritual change"was still significant(P<0.05).Thirdly,the transitional care intervention was significantly effects(group effect F=59.169,P<0.01)on the self-management ability.Independent-sample t-test showed that the PCI patients self-management ability was significant higher than control group at the 3 months and 6months after the intervention(P<0.01).Fourly,The transitional care intervention on the sialic acid,FB,LDLhad a significant effects(P<0.05).Independent-sample t-test showed that at three months after the end of the intervention,The PCI patients'sialic acid,Blood-glucose(FB),Total Cholesterol(TC),Triglyceride(TG),and Low Density Lipoprotein(LDL)was significant lower in intervention group than in control group.The PCI patients'diastolic Blood Pressure(DBP),sialic acid,Blood-glucose(FB),Triglyceride(TG),Low Density Lipoprotein(LDL)was significant lower in intervention group than in control group,While the level of Interleukin 6 and Tumor Necrosis Factor?(TNF-?)were no significant difference between intervention group and control group at the 3 months and 6 months after the interventionConclusions1.The level of self-management behaviour and quality of life in patients with percutaneous coronary intervention were lower,and the level of posttraumatic growth was moderate.2.Education level,depress and angina frequency can significantly predict the level of self-management ability.The level of self-management ability was positive correlated with the posttraumatic growth and the quality of life of PCI patients.3.Transitional care carried out by specialized nurses at the early stage after percutaneous coronary intervention can imcrease the patients'satisfaction,enhance the level of PTG and improve the patients'self-management behaviour,Transitional care can also reduce the leve of blood fat,Blood-glucose(FB),as well as the blood pressure of patients,It also can improve the patients'blood coagulation mechanism and the function and level of lipoprotein.