摘要
背景随着时代的发展和疾病谱的变化,慢性肾脏病(CKD)已成为危害人群健康的全球性公共卫生问题,造成巨大的疾病负担。以疾病治疗为中心的传统医学模式已落后于时代的发展,新型的慢性病管理模式强调发挥患者在疾病防治体系中的主体地位。因此,如何增强其自我管理能力(即患者积极度),已成为CKD随访管理的研究热点之一。目的探讨门诊随访的CKD患者积极度与心理困扰、社会支持的相关性,以期为提高患者参与疾病自我管理的积极度提供依据。方法本研究采用单中心、横断面、便利抽样的设计方法,运用患者积极度量表、凯斯勒心理困扰量表及社会支持评定量表,于2017年8月-2018年10月,调查南方医科大学南方医院肾病中心门诊定期随访的、非透析的、CKD 1~5期患者共301例。结果门诊随访的CKD患者按患者积极度得分分为1~4水平,各水平的中位得分分别为45.1(43.2,46.1)、51.1(51.1,52.6)、61.1(59.4,64.1)、73.1(68.1,77.0)分,构成比分别为12.3%(37/301)、18.3%(55/301)、36.5%(110/301)、32.9%(99/301)。患者积极度评分与心理困扰得分呈负相关(rs=-0.301,P<0.01),与社会支持总分及客观支持、主观支持、对社会支持的利用度维度得分呈正相关(rs值为0.195~0.359,P<0.01)。结论大部分门诊随访的CKD患者积极度水平不高,尚不具备参与疾病自我管理的知识、信心,缺乏维持健康促进行为的技能。此外,患者积极度与心理困扰呈负相关,与社会支持呈正相关。因此,在今后的CKD门诊随访管理中,可通过心理康复干预和强化社会支持来提高患者积极度。
Background Disease spectrum changes as time goes on.Chronic kidney disease(CKD)has become a global public health problem threatening people's health,causing a substantially great burden.The traditional disease-centered model is no longer applicable,the new appropriate chronic disease management model highlights the central role of the patient in disease prevention and treatment.Hence,how to increase patient self-management initiative,namely,patient activation,has become a research hotspot of CKD follow-up management.Objective To explore the correlation of activation with psychological distress and social support in CKD patients with outpatient follow-up management,providing evidence for improving patient activation.Methods A single-center,cross-sectional design with convenience sampling was adopted in the research carried out between August 2017 and October 2018.Participants were totally 301 non-dialysis patients with CKD stages 1-5 who received regular outpatient follow-up from the Clinic of Kidney Disease Center,Nanfang Hospital.They were investigated with Patient Activation Measure(PAM),Kessler Psychological Distress Scale(KPDS)and Social Support Scale.Results The rates with activation levels of 1-4 were 12.3%(37/301),18.3%(55/301),36.5%(110/301),and 32.9%(99/301),respectively,with corresponding mean evaluation score of 45.1(43.2,46.1),51.1(51.1,52.6),61.1(59.4,64.1),and 73.1(68.1,77.0),respectively.The PAM score was negatively correlated with KPDS score(rs=-0.301,P<0.01),but was positively correlated with the total score of social support,scores of objective support,subjective support and utilization of support(rs=0.195-0.359,P<0.01).Conclusion The activation for most CKD patients is not high,indicating that they have no sufficient self-management knowledge and confidence,and skills for health maintenance and promotion.In addition,CKD patients'activation increases with the growth of social support,but decreases with the aggravation of psychological distress.So the activation of such patients during the outpatient follow-up management may be enhanced by psychological rehabilitation interventions and increased social support.
作者
潘永毅
谢文鸿
贾翎
黄静欣
谢迪
杨小兵
陶晓蕾
赵豪
PAN Yongyi;XIE Wenhong;JIA Ling;HUANG Jingxin;XIE Di;YANG Xiaobing;TAO Xiaolei;ZHAO Hao(Department of Nephrology,Nanfang Hospital,Southern Medical University,Guangdong Provincial Institute of Nephrology,Guangzhou 510515,China;Editorial Department of Journal of Nursing,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中国全科医学》
CAS
北大核心
2020年第13期1647-1653,共7页
Chinese General Practice
基金
国家自然科学基金资助项目(81202280)。
关键词
慢性病
慢性肾脏病
患者积极度
心理健康
社会支持
相关性研究
Chronic disease
Chronic kidney disease
Patient activation
Mental health
Social support
Correlation study
