本文選題：老年　切入點(diǎn)：心血管疾病　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的構(gòu)建適合居家老年心血管病患者參與用藥安全管理的分階段漸進(jìn)性干預(yù)方案,并驗(yàn)證方案的可行性及有效性。方法本研究共分兩個(gè)階段。1.干預(yù)方案構(gòu)建階段:基于國內(nèi)外相關(guān)文獻(xiàn)分析,前期居家老年慢性病患者參與用藥安全的質(zhì)性研究,在動(dòng)機(jī)性訪談及互動(dòng)式患者參與患者安全理論框架的基礎(chǔ)上,初步構(gòu)建干預(yù)方案。通過專家咨詢,并對(duì)納入研究對(duì)象的用藥差錯(cuò)現(xiàn)狀進(jìn)行分析,結(jié)合預(yù)試驗(yàn),確定一套操作性較強(qiáng)、較易被接受的患者參與用藥安全管理方案。2.干預(yù)方案實(shí)施階段:2015年12月~2016年12月,選取鄭州市林山寨社區(qū)衛(wèi)生服務(wù)中心的8個(gè)居民社區(qū),以社區(qū)為單位,按人數(shù)多少進(jìn)行匹配,兩個(gè)社區(qū)為一組,分成四組,然后從每組中使用抽簽法隨機(jī)選一個(gè)進(jìn)入干預(yù)組,另一個(gè)進(jìn)入對(duì)照組。最終干預(yù)組51例,對(duì)照組53例。干預(yù)組實(shí)施患者參與用藥安全管理方案,共12周;對(duì)照組前3周健康教育同干預(yù)組,其余周次進(jìn)行常規(guī)隨訪。采用用藥差錯(cuò)調(diào)查表、合理服藥自我效能量表(Self-efficacy for Appropriate Medication Use Scale,SEAMS)及患者積極度量表(Patient Activation Measure,PAM)評(píng)價(jià)干預(yù)方案對(duì)居家老年心血管病患者參與用藥管理的用藥差錯(cuò)程度、合理服藥自我效能及積極度的影響,分別于干預(yù)前、干預(yù)后、干預(yù)后1個(gè)月及3個(gè)月收集資料。采用IBM SPSS Statistics 21.0軟件分析數(shù)據(jù),方法有描述性統(tǒng)計(jì)分析、t檢驗(yàn)、卡方檢驗(yàn)、Kruskal-Wallis秩和檢驗(yàn)、多重對(duì)應(yīng)分析、廣義估計(jì)方程、重復(fù)測(cè)量方差分析。結(jié)果共納入研究對(duì)象120例,樣本流失16例,流失率13.3%,有效樣本量104例。納入研究對(duì)象年齡65~87歲,平均年齡(73.25±5.40)歲。干預(yù)組(n=51)平均年齡(73.86±4.25)歲,對(duì)照組(n=53)平均年齡(72.66±6.29)歲。1.采用廣義估計(jì)方程分析7種用藥差錯(cuò)類型的變化情況:(1)存在組間效應(yīng)的用藥差錯(cuò)類型有:遺漏差錯(cuò)(Waldχ~2=47.223,P0.001)、時(shí)間差錯(cuò)(Waldχ~2=31.371,P0.001)、劑量差錯(cuò)(Waldχ~2=35.759,P0.001)、未授權(quán)差錯(cuò)(Waldχ~2=6.773,P=0.009)、不依從醫(yī)囑差錯(cuò)(Waldχ~2=4.319,P=0.038)及監(jiān)控差錯(cuò)(Waldχ~2=6.755,P=0.009)。(2)不存在組間效應(yīng)的用藥差錯(cuò)類型有:未關(guān)注處方差錯(cuò)(Waldχ~2=1.834,P=0.176)。(3)存在時(shí)間效應(yīng)的用藥差錯(cuò)類型有:未關(guān)注處方差錯(cuò)(Waldχ~2=74.437,P0.001)、遺漏差錯(cuò)(Waldχ~2=112.197,P0.001)、時(shí)間差錯(cuò)(Waldχ~2=114.940,P0.001)、劑量差錯(cuò)(Waldχ~2=100.171,P0.001)、未授權(quán)差錯(cuò)(Waldχ~2=70.691,P0.001)、不依從醫(yī)囑差錯(cuò)(Waldχ~2=77.856,P0.001)及監(jiān)控差錯(cuò)(Waldχ~2=87.052,P0.001)。隨時(shí)間增加,遺漏差錯(cuò)、時(shí)間差錯(cuò)及劑量差錯(cuò)程度降低后保持不變;未關(guān)注處方差錯(cuò)、不依從醫(yī)囑差錯(cuò)及監(jiān)控差錯(cuò)程度有遞增趨勢(shì);患者未授權(quán)差錯(cuò)程度先降低后增加,干預(yù)后3個(gè)月與基線相比差異無統(tǒng)計(jì)學(xué)意義(P=0.102)。2.合理服藥自我效能量表得分的重復(fù)測(cè)量方差分析結(jié)果顯示,存在組間效應(yīng)(F=31.632,P0.001)和時(shí)間效應(yīng)(F=832.994,P0.001),且測(cè)量前后組間效應(yīng)與時(shí)間效應(yīng)存在交互作用(F=367.434,P0.001)。交互輪廓圖顯示,隨時(shí)間延長(zhǎng),干預(yù)組合理服藥自我效能得分有下降趨勢(shì)。3.干預(yù)后干預(yù)組患者積極度總分均大于對(duì)照組患者積極度總分,差異有統(tǒng)計(jì)學(xué)意義(P0.001),進(jìn)一步分析可知:(1)重復(fù)測(cè)量方差分析結(jié)果顯示,存在組間效應(yīng)(F=42.698,P0.001)和時(shí)間效應(yīng)(F=305.557,P0.001),且測(cè)量前后組間效應(yīng)與時(shí)間效應(yīng)存在交互作用(F=270.424,P0.001)。交互輪廓圖顯示,隨時(shí)間延長(zhǎng),干預(yù)組患者積極度得分有下降趨勢(shì)。(2)采用廣義估計(jì)方程分析兩組患者不同積極度水平的人數(shù)情況,存在組間效應(yīng)(Waldχ~2=24.553,P0.001)和時(shí)間效應(yīng)(Waldχ~2=38.474,P0.001),且隨時(shí)間增加,患者積極度水平有下降趨勢(shì)。結(jié)論1.患者參與用藥安全管理方案易接受、可操作性較強(qiáng),可充分調(diào)動(dòng)患者積極性,促使其主動(dòng)參與或在家屬協(xié)助下主動(dòng)參與自身用藥安全的管理。2.實(shí)施患者參與用藥安全管理方案后,可降低居家老年心血管病患者常見用藥差錯(cuò)類型的差錯(cuò)程度,提高患者合理服藥自我效能與患者積極度。
[Abstract]:Objective to construct a progressive intervention program in stages for patients with cardiovascular disease in the elderly medication safety management, and verify the effectiveness and feasibility of the scheme. The research method is divided into two stages: construction stage.1. intervention program based on the analysis of the related literature at home and abroad, a qualitative study of early home elderly patients with chronic diseases in drug safety. Based on motivational interviewing and interactive patient safety on the theoretical framework, constructs the intervention program. Through expert consultation, and included in the study of the status quo of error analysis, combined with the pre test, determine a set of operational, is easily accepted by patients in the implementation of safety management scheme of.2. intervention project phase: December 2015 ~2016 year in December, selected 8 residents of Zhengzhou community forest copycat community health service center, community as a unit, according to the number of how many Matching, two community as a group, divided into four groups, then from each group were randomly selected using a into the intervention group, another into control group. 51 cases in the intervention group, 53 cases in the control group. The intervention group patients participating in drug safety management program, a total of 12 weeks; the control group 3 the same week health education intervention group, the remaining weeks were followed up. The reasonable medication medication errors questionnaire, self efficacy scale (Self-efficacy for Appropriate Medication Use Scale, SEAMS) and the patients with positive scale (Patient Activation Measure, PAM) to evaluate the degree of medication errors intervention on cardiovascular disease in elderly patients at home medication management. Reasonable medication self-efficacy and positive impact of the intervention, before intervention, respectively, after 1 months and 3 months to collect data. Data analysis using IBM SPSS Statistics 21 software, a descriptive statistical method Statistical analysis, t test, chi square test, Kruskal-Wallis rank test and multiple correspondence analysis, generalized estimating equations, analysis of variance of repeated measurement. Results a total of 120 subjects, 16 cases of sample loss, the loss rate is 13.3%, the effective sample size of 104 cases were included in the study. The age of 65~ 87, the average age (73.25. At the age of 5.40). The intervention group (n=51) the average age (73.86 + 4.25), control group (n=53) the average age (72.66 + 6.29).1. using generalized estimating equations and analyze the changes of 7 kinds of error types: (1) error types exist between group effects: the omission errors (Wald x ~2=47.223, P0.001), time error (Wald x ~2=31.371, P0.001), dose error (Wald x ~2=35.759, P0.001), unauthorized error (Wald x ~2=6.773, P=0.009), compliance order error (Wald x ~2=4.319, P=0.038) and monitoring error (Wald x ~2=6.755, P=0.009). (2) there were no the difference between the effect of medication Wrong type: not on prescription errors (Wald x ~2=1.834, P=0.176). (3) error types exist time effect are: not prescription errors (Wald x ~2=74.437, P0.001), omission errors (Wald x ~2=112.197, P0.001), time error (Wald x ~2=114.940, P0.001), dose error (Wald x ~2=100.171, P0.001), unauthorized error (Wald x ~2=70.691, P0.001), compliance order error (Wald x ~2=77.856, P0.001) and monitoring error (Wald x ~2=87.052, P0.001). With the increase of time, the omission errors remain unchanged, time error and dose error decreased; not prescription errors, not order error and error monitoring compliance degree of patients have an increasing trend; unauthorized error degree decreased firstly and then increased, 3 months after the intervention compared with the baseline, there was no statistically significant difference (P=0.102).2. reasonable medication self-efficacy results of repeated measurements analysis of variance scores showed that there The effect between the groups (F=31.632, P0.001) and the effect of time (F=832.994, P0.001), and there was an interaction between the groups before and after the measurement and time effects (F=367.434, P0.001). The interaction profile, with the extension of time, the intervention group score reasonable medication self-efficacy had declined after intervention in the intervention group patients with positive.3. score were higher than the control group in patients with a positive score, the difference was statistically significant (P0.001), further analysis shows that: (1) repeated measures analysis of variance showed that there were effects (F=42.698, P0.001) and the effect of time (F=305.557, P0.001), and there was an interaction between the groups before and after the measurement and time effects (F=270.424. P0.001). Interactive contour maps show that with time, patients in the intervention group positive scores decreased. (2) using generalized estimating equation analysis of the number of different levels of extreme product in two groups, there were effects (Wald X ~2=24.553, P0.001) and time effect (Wald x ~2=38.474, P0.001), and increased with time, with positive level decreased. Conclusion the 1. patients involved in drug safety management program is easy to accept, strong operability, can fully mobilize the enthusiasm of patients, promote their active participation in the implementation or patients involved in drug safety management program in the family assistance to actively participate in its drug safety management.2., can reduce the error level of patients with common cardiovascular disease in elderly patients with type of medication errors, improve medication self-efficacy in patients with active and reasonable degree.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳卓然;謝學(xué)勤;康曉平;代曉彤;劉福榮;;北京市青壯年人群慢性病患病相關(guān)因素的多重對(duì)應(yīng)分析[J];中國衛(wèi)生統(tǒng)計(jì);2017年01期

2 周玉剛;王爽;張陸;肖煥;赫曙光;劉雪君;于凱;趙心;于曉松;;沈陽市長(zhǎng)白社區(qū)慢性病共病患病情況及老年患者積極度與健康結(jié)局的相關(guān)性研究[J];中國全科醫(yī)學(xué);2017年04期

3 劉冬梅;張佳淇;李勝玲;劉國蓮;;基于授權(quán)理論的家庭訪視護(hù)理對(duì)社區(qū)老年糖尿病患者積極度及家庭功能的影響[J];中國老年學(xué)雜志;2017年03期

4 陳玲;陳彬;;合理用藥自我效能對(duì)冠心病患者服藥依從性行為階段的影響[J];中華現(xiàn)代護(hù)理雜志;2016年31期

5 張慧玲;王盼盼;張振香;;患者參與在臨床護(hù)理中的研究現(xiàn)狀與啟示[J];中國醫(yī)院管理;2016年10期

6 吳清;葉旭春;李曉芳;趙麗;巫雅萍;;臨床護(hù)士感知患者參與患者安全現(xiàn)狀分析[J];護(hù)理學(xué)雜志;2016年15期

7 張慧玲;王盼盼;張振香;;患者參與用藥安全干預(yù)研究的現(xiàn)狀及啟示[J];實(shí)用醫(yī)學(xué)雜志;2016年12期

8 謝豪;何嘉麗;;糖尿病老年患者的用藥依從性綜合干預(yù)效果評(píng)價(jià)[J];實(shí)用藥物與臨床;2016年06期

9 馮嬌;呂廣梅;;南京市江浦街道老年人用藥情況調(diào)研[J];中國衛(wèi)生產(chǎn)業(yè);2016年12期

10 金鋒;周麗文;吳建華;倪進(jìn)東;蕭曉東;趙婉月;盧美玲;;慢性病患者參與社區(qū)慢病管理的意愿及其影響因素的調(diào)查研究[J];中國現(xiàn)代醫(yī)藥雜志;2016年03期

相關(guān)博士學(xué)位論文 前1條

1 葉旭春;患者參與患者安全的感知及理論框架的扎根理論研究[D];第二軍醫(yī)大學(xué);2011年

，

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