本文關(guān)鍵詞：慢性絲蟲(chóng)病患者社區(qū)照料及疾病經(jīng)濟(jì)負(fù)擔(dān)調(diào)查　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 絲蟲(chóng)病 社區(qū)照料 疾病經(jīng)濟(jì)負(fù)擔(dān) 現(xiàn)況研究 病例對(duì)照研究

【摘要】：目的 為了解震澤鎮(zhèn)消除絲蟲(chóng)病后慢性絲蟲(chóng)病患者的患病、轉(zhuǎn)歸、關(guān)懷照料效果以及疾病經(jīng)濟(jì)負(fù)擔(dān)情況，從而為進(jìn)一步做好關(guān)懷和照料慢性絲蟲(chóng)病患者工作提供科學(xué)依據(jù)。 方法 以蘇州市吳江區(qū)震澤鎮(zhèn)50周歲以上的常住居民為調(diào)查對(duì)象，采用現(xiàn)況研究方法對(duì)慢性絲蟲(chóng)病患者現(xiàn)況進(jìn)行調(diào)查，結(jié)合配比病例對(duì)照研究方法對(duì)慢性絲蟲(chóng)病患者和非慢性絲蟲(chóng)病人群進(jìn)行疾病經(jīng)濟(jì)負(fù)擔(dān)影響因素調(diào)查。采用統(tǒng)一設(shè)計(jì)的調(diào)查表，由經(jīng)過(guò)統(tǒng)一培訓(xùn)的鎮(zhèn)醫(yī)院醫(yī)護(hù)人員進(jìn)行面對(duì)面詢問(wèn)并填寫(xiě)調(diào)查表，對(duì)慢性絲蟲(chóng)病的患者的一般情況（性別、年齡、戶口所在地、本地累計(jì)居住時(shí)間、文化程度、職業(yè)、醫(yī)療保障、疾病健康狀況等）、隨訪情況（雙腿象皮腫程度、流火年發(fā)作次數(shù)、病程、好發(fā)季節(jié)、誘因、治療及照料情況等）、經(jīng)濟(jì)狀況（個(gè)人全年純收入、家庭全年純收入、共享收入人口數(shù)、居住面積、共居人口數(shù)、是否為低保戶）、醫(yī)療花費(fèi)（自我醫(yī)療花費(fèi)、就診醫(yī)療花費(fèi)、間接醫(yī)療花費(fèi)）進(jìn)行調(diào)查。原始資料經(jīng)核對(duì)后使用Epidata3.0軟件進(jìn)行雙人雙機(jī)錄入，錄入后的資料經(jīng)邏輯核查無(wú)誤后統(tǒng)一轉(zhuǎn)化為SPSS18.0數(shù)據(jù)庫(kù)，采用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料用均數(shù)（）±標(biāo)準(zhǔn)差（S）表示，計(jì)數(shù)資料以構(gòu)成比或率表示，組間比較采用2檢驗(yàn)或用t檢驗(yàn)進(jìn)行統(tǒng)計(jì)推斷。 結(jié)果 1、震澤鎮(zhèn)1998年消除絲蟲(chóng)病后，無(wú)新發(fā)慢性絲蟲(chóng)病患者；原慢性絲蟲(chóng)病患者764例，至2013年尚存117例，分別比基本消除絲蟲(chóng)病和2002年普查時(shí)自然減少84.68%、44.81%，分布區(qū)域已明顯縮小；遺留的患者年齡以70～79歲老年人居多，占58.12%；患者病程多在50～59年，占54.70%；淋巴液腫部位和分期以右下肢和Ⅱ～I(xiàn)II期為主，分別占整個(gè)病例的40.17%、46.16%。 2、通過(guò)社區(qū)、家庭/自我照料后，現(xiàn)存117例慢性絲蟲(chóng)病患者淋巴水腫分期高的患者逐漸減少，分期低的患者增多，與照料前相比較，差別具有統(tǒng)計(jì)學(xué)意義(＜0.05)，，說(shuō)明病情好轉(zhuǎn)，且患者下肢淋巴管/結(jié)炎、急性大、小發(fā)作和下肢潰瘍的發(fā)生情況明顯好轉(zhuǎn)（P＜0.05）。 3、震澤鎮(zhèn)慢性絲蟲(chóng)病患者的個(gè)人年純收入、家庭純收入、共享收入人口數(shù)、居住面積、共同居住人口數(shù)、是否低保戶等6項(xiàng)經(jīng)濟(jì)情況與未患病組相仿，兩組間差別無(wú)統(tǒng)計(jì)學(xué)意義（均P＞0.05）。 4、慢性絲蟲(chóng)病患者的醫(yī)療花費(fèi)除家屬陪同費(fèi)用和患者誤工費(fèi)用外，自我醫(yī)療、直接醫(yī)療（門(mén)診費(fèi)、住院費(fèi)）、間接醫(yī)療(交通費(fèi)、住宿費(fèi))均大于未患絲蟲(chóng)病組，兩組間總體醫(yī)療費(fèi)用的差別有統(tǒng)計(jì)學(xué)意義（均P＜0.001）。自我醫(yī)療、直接醫(yī)療（門(mén)診費(fèi)、住院費(fèi)）的自付比例，患病組均大于未患病組，差別有統(tǒng)計(jì)學(xué)意義（均P＜0.001）。 結(jié)論 1、震澤鎮(zhèn)消除絲蟲(chóng)病后，慢性絲蟲(chóng)病患者明顯減少，表現(xiàn)為高齡化、病程長(zhǎng)的特點(diǎn)。 2、采用WHO推薦的社區(qū)、家庭/自我照料措施，能夠改善慢性絲蟲(chóng)病患者的病情，阻止疾病的進(jìn)展，照料效果肯定，推薦在基層社區(qū)推廣。 3、震澤鎮(zhèn)慢性絲蟲(chóng)病患者的經(jīng)濟(jì)收入狀況與未患慢性絲蟲(chóng)病人群相仿。 4、震澤鎮(zhèn)慢性絲蟲(chóng)病患者各項(xiàng)醫(yī)療花費(fèi)（除家屬陪同費(fèi)用和患者誤工費(fèi)用外）均高于未患絲蟲(chóng)病人群，自付比例也明顯高于未患絲蟲(chóng)病人群。建議政府部門(mén)給予這部分人群特殊醫(yī)療救助或者提高報(bào)銷比例。
[Abstract]:objective
In order to understand the Zhenze town after filariasis elimination in patients with chronic filariasis patients, care effect and economic burden of disease, so as to provide scientific basis for the improvement of care and work in patients with chronic filariasis.
Method
The residents of Zhenze town of Wujiang District of Suzhou city for more than 50 years of age for the survey, the current research methods to investigate the status of patients with chronic filariasis, matched case-control study method of disease economic negative factors on the load survey of patients with chronic filariasis and non chronic filariasis patients. With unified questionnaire, face-to-face inquiry and fill out the questionnaire by the medical staff trained town hospital, the general situation of chronic filariasis patients (gender, age, residence, local residence time, education, occupation, medical security, health and other diseases), follow-up (legs elephantiasis, Liuhuo years episodes, duration well, the season, causes, treatment and care etc.), economy (personal annual net income, average annual family income, the share of income population, living area, a total of In the population, whether households), medical expenses (self medical expenses, medical expenses, indirect medical costs) were investigated. The original data were checked using Epidata3.0 software double dual input, input the data after the logic verification is correct after unified into the SPSS18.0 database, using SPSS18.0 software for statistical analysis by mean of measurement data (standard deviation) (S) said the count data expressed as a proportion or rate, comparison between groups using the 2 test or t test was used for statistical inference.
Result
In 1998 1, Zhenze town after filariasis elimination, no new cases of chronic filariasis patients; 764 cases of primary chronic filariasis patients surviving to 2013 117 cases, respectively than the basic elimination of filariasis and 2002 census natural distribution area decreased by 84.68%, 44.81%, has been significantly reduced; the remaining patients aged 70 to 79 years old are 58.12%; patients accounted for 54.70% in 50 to 59 years; the swollen lymph site and stage to the right lower extremity and II ~ III, accounted for 40.17% of cases, 46.16%.
2, through the community, family / self care, 117 cases of existing chronic filariasis patients with lymphedema in patients with high stage decreased, increased low stage patients, compared with care before, the difference was statistically significant (P < 0.05), indicating the condition improved, and patients with lower limb lymphatic node / inflammation, acute. Small seizures and lower limb ulcer improved (P < 0.05).
3, personal annual income of Zhenze town of patients with chronic filariasis, family income, revenue sharing population, living area, living in a common population, whether low household economic situation and 6 unaffected groups are similar, the difference between the two groups was not statistically significant (P > 0.05).
4, the cost of medical treatment in patients with chronic filariasis patients accompanied by family members costs and delay costs, self care, medical (outpatient fees, hospitalization expenses), indirect medical (transportation fees, accommodation fees) were higher than those of patients in group, the two groups have significant differences in overall medical costs (P < 0.001) self care, medical (outpatient fees, hospitalization fee) the proportion of payment, disease group were higher than those in group, the difference was statistically significant (P < 0.001).
conclusion
1, Zhenze town of elimination of filariasis after chronic filariasis patients decreased significantly, as aging, the characteristics of long duration.
2, using WHO recommended family / family care measures can improve the condition of chronic filariasis patients, prevent disease progression, and ensure the effect of care. It is recommended to promote in the grass-roots community.
3, the economic income of Zhenze town of patients with chronic filariasis patients with chronic filariasis group is similar.
4, Zhenze town of chronic filariasis patients with various medical costs (except families accompanied by costs and patient delay costs) were higher than those of patients without filariasis patients group, pay a significantly higher proportion of patients without filariasis patients group. Suggest the government departments to give this part of the crowd or special medical assistance to improve reimbursement.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R532.15

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