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目的调查北京市德胜社区家庭医生式服务开展初期,签约慢性病患者的健康行为现状并探讨其影响因素,为有效进行健康行为干预、提高家庭医生式服务质量提供依据。方法采用单纯随机抽样方法,按患者档案号随机抽取2012年9—12月在德胜社区卫生服务中心门诊签约的420例慢性病(高血压、糖尿病)患者,采用自行设计的社区慢性病患者健康行为调查表调查慢性病患者一般资料、健康行为、知识与态度。结果签约慢性病患者的总体健康行为呈中等水平,总分为(60.07±8.51)分,总体达标率为55.48%(233/420)。健康行为各维度得分分别为:饮食(31.35±5.42)分,达标率为73.10%(307/420);运动(9.25±3.46)分,达标率为50.48%(212/420);嗜好(7.24±1.61)分,达标率为82.62%(347/420);心理调节(8.37±1.83)分,达标率为75.71%(318/420);遵医行为(3.87±1.80)分,达标率为30.95%(130/420)。慢性病相关知识(8.44±2.95)分,达标率为46.90%(197/420);患者对疾病的态度(7.96±1.77)分,达标率为66.43%(279/420)。Pearson相关分析结果显示,健康行为与知识呈正相关(r=0.118,P=0.015);健康行为与态度无直线相关性(r=-0.042,P=0.391)。多元线性回归分析结果显示,体质指数与运动相关,性别和知识与嗜好相关,知识和病程与心理有关,知识和病种与遵医行为相关(P<0.05)。结论签约慢性病患者健康行为现状不理想,其中进食早餐、控制烟酒及遵医嘱服药较好;饮食中油盐控制、运动异常处理及血糖监测较差。患者的知识、性别、病程是主要影响因素,家庭医生式服务团队在制定签约慢性病患者的行为干预措施时要针对患者不同的性别及病程阶段,在传授慢性病相关知识的同时,更加注重培养患者的自我管理技能,以更好地改善并维持其健康行为,提高家庭医生式服务质量。
Objective To investigate the status quo of health behaviors of contracted chronic patients and explore the influencing factors during the initial stage of family doctor service in Beijing Desheng community to provide the basis for effective intervention in health behaviors and improvement of family doctor service. Methods A total of 420 patients with chronic diseases (hypertension and diabetes) who were contracted in the Desheng Community Health Center from September to December in 2012 were randomly selected according to the patient’s file number. The health behaviors of patients with chronic diseases Table for chronic disease general information, health behavior, knowledge and attitude. Results The overall health behaviors of patients with contracted chronic diseases were moderate, with a total score of (60.07 ± 8.51) points and an overall compliance rate of 55.48% (233/420). The scores of health behaviors in all dimensions were as follows: diet (31.35 ± 5.42), achievement rate of 73.10% (307/420) and exercise (9.25 ± 3.46), the compliance rate was 50.48% (212/420) 1.61), the compliance rate was 82.62% (347/420); The psychological adjustment was (8.37 ± 1.83) points, the compliance rate was 75.71% (318/420); The compliance rate was 3.87 ± 1.80, the compliance rate was 30.95% (130/420). Chronic disease-related knowledge (8.44 ± 2.95) points, the compliance rate was 46.90% (197/420); patients with disease attitude (7.96 ± 1.77) points, the compliance rate was 66.43% (279/420). Pearson correlation analysis showed that there was a positive correlation between healthy behavior and knowledge (r = 0.118, P = 0.015). There was no linear correlation between healthy behavior and attitude (r = -0.042, P = 0.391). Multivariate linear regression analysis showed that body mass index was related to exercise, gender and knowledge were related to hobby, knowledge and disease duration were related to psychology, and knowledge and disease were related to compliance (P <0.05). Conclusion The status quo of health behaviors among patients with contracted chronic diseases is not satisfactory. Among them, eating breakfast, controlling smoking, drinking alcohol and taking prescribed medicine are better. The control of salt and oil in diet, abnormal exercise and blood glucose monitoring are poor. Patient’s knowledge, gender and course of disease are the main influencing factors. When formulating behavioral interventions for patients with chronic diseases, the family doctor-service team should pay more attention to the training of patients with the knowledge of chronic diseases as well as the different gender and course of disease stages Self-management skills to better improve and maintain their health behaviors and improve the quality of family doctor services.