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目的:探讨基层医院慢性心力衰竭(CHF)疾病管理的方法和途径。方法:通过对144例CHF疾病管理,开展健康教育、系统指导、定期随访,填写自理能力量表、回访登记表,定期评估自理能力与药物规范使用率的变化。结果:CHF患者管理后各时间段的自理能力与药物规范使用率均有明显的提高,且连续保持较高水平。结论:宣传普及CHF防治知识,开展患者健康教育,设立CHF门诊系统指导和定期随访是CHF疾病管理的有效途径。
Objective: To explore the methods and approaches of disease management in primary hospital of chronic heart failure (CHF). Methods: 144 cases of CHF disease management, health education, systematic guidance, regular follow-up, self-care ability to fill in the form, visit the registration form, regular assessment of self-care ability and the changes in the use of drug norms. Results: The self-care ability and medication usage rate of patients with CHF were significantly improved after management, and maintained a high level continuously. Conclusion: It is an effective way to promote the disease management of CHF by publicizing and popularizing knowledge of prevention and treatment of CHF, carrying out patient health education, establishing guidance and regular follow-up of CHF outpatient system.