摘要
目的 探讨小儿腹泻病的管理医疗模式。方法 采用管理医疗3级网络模式,即:省级医院-区卫生院、卫生站-家庭3级模式,运用健康教育信息传播和行为干预的方法,促使医患对象实现知、信、行的改变。结果 干预后医务人员的腹泻病知识分数及相关知识答题正确率较干预前明显提高,使口服补液盐(oral rehydrationsalt,ORS)使用率明显增加、静脉输液率下降,抗生素、抗腹泻药物使用率明显下降。经济效益分析结果显示省级医院平均每张处方费用干预后较干预前明显下降。干预后患儿看护人的腹泻病知识合格率有不同程度提高,相关治疗行为也有相应改变,其中正确配制ORS者的比例由6.9％升至80.4％,患儿戒口率由95.1％降至55.9％,试验组明显低于对照组,差异有显著性意义。结论 1)在城市腹泻病的临床及家庭病例处理中存在着的问题急待解决。2)实施小儿腹泻病管理医疗,传播新的腹泻病诊治知识,改变了医务人员及看护人的观念、行为,由此提高了ORS使用率,减少了抗生素、静脉输液及抗腹泻药使用率,降低了腹泻病的再发率,使腹泻病的一套规范化治疗措施(基于证据支持)得到落实,而取得了明显经济效益和社会效益。3)小儿腹泻病的管理医疗3级网络模式经济、方法简便、针对性强,应用效果显著,值得在城市进一步推广。
Objective: To search for three-grade pattern of managed care for diarrhea disease in children. Methods: We developed an three-grade health education model for the traming of health workers and caretakers in intervention group to improve their knowledge, attitude and practice in diarrhea disease. Results: After intervention, knowledge scores of health workers in both teaching hospital and districl small hospitals become higher than pre-intervention and non-intervention group. The rate of ORS use was increased. The rales of intravenous use, antibiotics use and antidiarrhea drugs use were decreased obviously. Health providers can offer more advice to caretakers except continued feeding. Cost benefit evaluation of the effectiveness of the intervention showed that the median price of one prescription in the teaching hospital is 68. 07 yuan in pre-intervention and 36. 85 yuan in post-intervention. It suggested that effectiveness of this control were cost-effective. Results of health education intervention on caretakers showed that their knowledge about prevention and treatment of diarrhea have improved in various degrees. The rate of knowing 3 rules for treating diarrhea at home increased form 3. 9% to 85. 3% ; the rate ol knowing reasons for bring a child with diarrhea to see doctor increased from 14.7% to 93. 1% ; the rate ol restricted diet decreased from 95. 1% to 55. 9% . The rates of diarrhea reoccurrence of the intervention group and the control group were 6. 86% and 19. 61% respectively. The difference was statistically significant ( P < 0. 05). Conclusions: 1 )The problems of clinical and home case management of diarrhea disease are in urgent need of being resolved in urban areas. 2) Health education intervention improved the knowledge, attitude and practice of health workers and caretakers by transmitting
the new messages in treatment of diarrhea disease. As a result, the rale of ORS use increased. The rates of intravenous use and drug use decreased obviously. The rate of diarrhea reoccurrence decreased. Meanwhile, clinical medical cost was also reduced. 3) Managed care pattern is economic, convenient, effective, suitable for our national conditions and can be recommended lor further implementation.
出处
《循证医学》
CSCD
2002年第1期13-18,共6页
The Journal of Evidence-Based Medicine
基金
广东省卫生厅基金(A1997181)
关键词
小儿
腹泻
治疗
健康教育
药物
diarrhea
children
early intervention(education)
fluid-therapy
managed care
