慢性阻塞性肺疾病患者就医行为指导方案的构建

doi:10.3761/j.issn.0254-1769.2022.17.002

摘要/Abstract

摘要：

目的构建COPD患者就医行为指导方案,为指导COPD患者正确就医提供参考。方法 2020年12月—2021年5月,采用文献回顾、专家小组讨论制订COPD患者就医行为指导方案初稿,17名专家进行2轮德尔菲函询,确定COPD患者就医行为指导方案的内容。结果共进行2轮函询,2轮问卷有效回收率均为100%,专家权威系数为0.89,肯德尔和谐系数分别为0.173、0.248（P<0.001）。各条目的可行性赋值均数为4.06~4.94,变异系数为0.05~0.19。最终形成的方案包括31个情境,其中症状指导模块10个,药物指导模块12个,随访指导模块9个。结论 COPD患者就医行为指导方案具有较强的科学性、可靠性,可为指导COPD患者就医提供依据。

关键词: 慢性阻塞性肺疾病, 就医行为, 德尔菲技术, 护理

Abstract:

Objective To construct a health care seeking behavior guidance program for COPD patients,and to provide references for guiding COPD patients to seek medical treatment. Methods From December 2020 to May 2021,through literature review and expert group discussion,the first draft of the guidance program of health care seeking behavior for COPD patients was formulated,and the Delphi expert consultation method was used to conduct questionnaire consultations with 17 experts across the country to determine the content of the guidance program. Results There were 2 rounds of expert consultations. The effective recovery rate of the 2 rounds of the questionnaire was 100%;the expert authority coefficient was 0.89;Kendall harmony coefficient was 0.173 and 0.248 （P<0.001）,respectively. The mean feasibility values of each item ranged from 4.06 to 4.94,and the coefficient of variation ranged from 0.05 to 0.19. The final program included 31 specific situations,including 10 symptom guidance parts,12 medication guidance parts,and 9 follow-up guidance parts. Conclusion The guidance program of health care seeking behavior for COPD patients was scientific and reliable,which can provide a basis for guiding COPD patients to seek medical treatment.

Key words: Chronic Obstructive Pulmonary Disease, Health Care Seeking Behavior, Delphi Technique, Nursing Care

杨富凯, 钮美娥, 韩燕霞, 吴振云, 周丹丹. 慢性阻塞性肺疾病患者就医行为指导方案的构建[J]. 中华护理杂志, 2022, 57(17): 2060-2067.

YANG Fukai, NIU Mei’e, HAN Yanxia, WU Zhenyun, ZHOU Dandan. Construction of a guidance program of health care seeking behavior for COPD patients[J]. Chinese Journal of Nursing, 2022, 57(17): 2060-2067.

图/表 1

参考文献 25

[1]	Global strategy for the diagnosis,management, and prevention of chronic obstructive pulmonary disease(2022 REPORT)[EB/OL]. [2022-2-27]. https://goldcopd.org/2022-gold-reports-2/.
[2]	Wang C, Xu JY, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China(the China Pulmonary Health[CPH] study):a national cross-sectional study[J]. Lancet, 2018, 391(10131):1706-1717. DOI URL
[3]	张义静, 李娟, 孙丽, 等. 慢性阻塞性肺疾病患者早期简易肺康复方案的构建及应用[J]. 中华护理杂志, 2020, 55(5):690-695. DOI
	Zhang YJ, Li J, Sun L, et al. Construction of an early simple pulmonary rehabilitation programme for patients with COPD and its evaluation of effectiveness[J]. Chin J Nurs, 2020, 55(5):690-695.
[4]	邱玮, 杨华. 慢性阻塞性肺疾病的社区管理[J]. 上海医药, 2017, 38(18):51-54.
	Qiu W, Yang H. Community management of chronic obstructive pulmonary disease[J]. Shanghai Med & Pharm J, 2017, 38(18):51-54.
[5]	阚亚楠. 慢性阻塞性肺疾病患者就医行为现状及其影响因素分析[D]. 苏州: 苏州大学, 2020.
	Kan YN. Analysis of the status of healthcare seeking behavior and its influencing factors in patients with chronic obstructive pulmonary disease[D]. Suzhou: Soochow University, 2020.
[6]	Chandra D, Tsai CL, Camargo CA. Acute exacerbations of COPD:delay in presentation and the risk of hospitalization[J]. COPD, 2009, 6(2):95-103. DOI PMID
[7]	Rodriguez Hermosa JL, Fuster Gomila A, Puente Maestu L, et al. Compliance and utility of a smartphone app for the detection of exacerbations in patients with chronic obstructive pulmonary disease:cohort study[J]. JMIR Mhealth Uhealth, 2020, 8(3):e15699.
[8]	徐迅, 李凡, 朱云霞, 等. 社区规范化管理对慢性阻塞性肺疾病患者质量调整生命年的影响研究[J]. 中国全科医学, 2013, 16(9):798-801.
	Xu X, Li F, Zhu YX, et al. The effect of community standardized management on quality adjusted life year of patients with chronic obstructive pulmonary disease[J]. Chin Gen Prac, 2013, 16(9):798-801.
[9]	Locke ER, Young JP, Battaglia C, et al. Care-seeking and delay of care during COPD exacerbations[J]. NPJ Prim Care Respir Med, 2022, 32(1):7. DOI URL
[10]	Arjun P, Nair S, Jilisha G, et al. Assessing health-seeking behavior among Asthma and COPD patients in urban South India[J]. J Family Med Prim Care, 2019, 8(8):2714-2719. DOI URL
[11]	郭玉婷. 慢性阻塞性肺疾病患者直接经济负担关联规则分析[D]. 天津: 天津医科大学, 2017.
	Guo YT. Analysis on the direct economic burden of patients with chronic obstructive pulmonary disease using association rules mining[D]. Tianjin: Tianjin Medical University, 2017.
[12]	Hallensleben C, Meijer E, Biewenga J, et al. Reducing delay through education on exacerbations(REDUX) in patients with COPD:a pilot study[J]. Clinical eHealth, 2020, 3:63-68. DOI URL
[13]	唐国宝, 林民强, 李卫华. 分级诊疗“厦门模式”的探索与评价[J]. 中国全科医学, 2016, 19(22):2624-2627. DOI
	Tang GB, Lin MQ, Li WH. Exploration and evaluation of hierarchical diagnosis and treatment of “Xiamen mode”[J]. Chin Gen Pract, 2016, 19(22):2624-2627.
[14]	倪云霞, 刘素珍, 李继平, 等. 护士主导的管理模式对社区糖尿病患者血糖控制及就医行为的影响[J]. 中华护理杂志, 2017, 52(2):222-227.
	Ni YX, Liu SZ, Li JP, et al. Effects of nurses-led management model on blood glucose control and health service utilization among diabetic patients in community[J]. Chin J Nurs, 2017, 52(2):222-227.
[15]	金静芬, 李梅, 陈圆圆, 等. 脑卒中患者早期运动康复护理方案的构建[J]. 中华护理杂志, 2020, 55(9):1360-1365. DOI
	Jin JF, Li M, Chen YY, et al. Construction of early motor rehabilitation nursing program based on Modified Barthel Index grading for stroke patients[J]. Chin J Nurs, 2020, 55(9):1360-1365.
[16]	Barnes N, Calverley PM, Kaplan A, et al. Chronic obstructive pulmonary disease and exacerbations:patient insights from the global hidden depths of COPD survey[J]. BMC Pulm Med, 2013, 13:54. DOI PMID
[17]	Jones PW, Lamarca R, Chuecos F, et al. Characterisation and impact of reported and unreported exacerbations:results from ATTAIN[J]. Eur Respir J, 2014, 44(5):1156-1165. DOI PMID
[18]	Dai ZS, Ma YM, Zhan ZJ, et al. Analysis of diagnostic delay and its influencing factors in patients with chronic obstructive pulmonary disease:a cross-sectional study[J]. Sci Rep, 2021, 11(1):14213. DOI URL
[19]	王蕊琪, 周郁秋, 贾红红. 慢性病患者就医行为影响因素研究进展[J]. 护理学报, 2018, 25(3):24-28.
	Wang RQ, Zhou YQ, Jia HH. Research progress on influencing factors of medical seeking behavior of patients with chronic diseases[J]. J Nurs China, 2018, 25(3):24-28.
[20]	阚亚楠, 钮美娥, 耿敏, 等. 慢性阻塞性肺疾病患者延迟就医原因的质性研究[J]. 护理学杂志, 2019, 34(17):36-38.
	Kan YN, Niu ME, Geng M, et al. Causes of delayed medical seeking among patients with chronic obstructive pulmonary disease:a qualitative study[J]. J Nurs Sci, 2019, 34(17):36-38.
[21]	姜宗良, 王海播, 王语嫣, 等. 慢性阻塞性肺疾病急性发作期患者就医延迟行为的现象学研究[J]. 中国全科医学, 2020, 23(27):3396-3401.
	Jiang ZL, Wang HB, Wang YY, et al. A phenomenology study on medical delay in patients with acute exacerbation of COPD[J]. Chin Gen Pract, 2020, 23(27):3396-3401.
[22]	Ejiofor SI, Stolk J, Fernandez P, et al. Patterns and characterization of COPD exacerbations using real-time data collection[J]. Int J Chron Obstruct Pulmon Dis, 2017, 12:427-434. DOI URL
[23]	李昕怿. 四川省慢性阻塞性肺疾病直接经济负担研究[D]. 成都: 西南财经大学, 2019.
	Li XY. Assessing the direct economic burden of chronic obstructive pulmonary disease in Sichuan Province[D]. Chengdu: Southwestern University of Finance and Economics, 2019.
[24]	张璐, 乔建歌, 解薇, 等. 老年慢性阻塞性肺疾病患者的健康教育需求现状[J]. 中国老年学杂志, 2016, 36(16):4079-4081.
	Zhang L, Qiao JG, Xie W, et al. Health education needs of elderly patients with chronic obstructive pulmonary disease[J]. Chin J Gerontol, 2016, 36(16):4079-4081.
[25]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3):170-205.
	Group of Chronic Obstructive Pulmonary Disease,Respiratory Branch of Chinese Medical Association, Working Committee of Chronic Obstructive Pulmonary Disease, Respiratory Branch of Chinese Medical Association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease(revised version 2021)[J]. Chin J Tuberc Respir Dis, 2021, 44(3):170-205.