搞好哮喘教育管理改变医疗服务模式

1、Enhancing the education management on Asthmachanging the model of medical servicePeking University Renmin Hospital He Quanying .So many problems existed in medical service, why? What the solutions? Difficulties: unfair locations of the medical resources countryside urban High cost：different forms fo

2、r medical cost new drugs development slowly increased of peoples income Health reform the hospital development service for profit .Unhealthy doctor-patient relationship becomes more and more tension: trustless restricting the very development of physicians Why? The way paid for medical service chang

3、ed constitution of the hospitals , professionalism education, medical reform, Excessive Medical Care , Negative function of the multimedia .mission for medicineProfit-for public hospitals, physicians lost themselves Seeking to make a profit Work passively Promoting the health of all. in this complic

4、ated context, what physicians should do? how?. the administration of Asthma began in 1993 in China, after many years practice and exploration, the following model formed. 三三位位一一体体医医疗疗服服务务模模式式 哮喘宣教中心 哮喘专病门诊 哮喘患者协会 .special service for Asthma is the primary point for education management on Asthma. Ph

5、ysician there will be responsible for the diagnosis, making plan on treatment and so on. public education center on Asthma is the further step, it makes more convenience for doctor-patient communications. The association of asthma patients is the platform we carry out our education, it provides a id

6、eal atmosphere between doctor and patient. Doctor-patient relationship is the fatal factor here. The association of asthma patients founded in May,2001. More than 700 members now. An activity will be hold at weekend every four months (free). Members will be informed and take part in as they want. Al

7、ways 100-150 members. . Content:Lectures on Asthma control;Communication between asthma patients, etc. It will be changed depend on the members willing, but always concentrate on the Asthma control & Asthma control in China. . “Public education center on Asthma founded in Nov,2001.A specialist gives

8、 advise, also some training to his patients . give patients free materials develop volunteers make up files ,etc. . “special service for Asthma began in April,2003.A specialist will provide his services. . patients get their diagnosis and relative treatment plan; know more on Asthma; also have more

9、confidence. . relative activities of doctors on Asthma .Long term treatment for Asthma control and managementevaluatingWorking for goalsMonitor and maintain the control . in 2005表1 the basic knowledge known by patients 分组 调查人数哮喘是一种慢 性 疾 病 哮喘变应性炎 症 本 质 激素是控制气道炎症最有效药物 吸入疗法用药的优点 吸入型药物正 确 用 法 峰速仪为监测病情重要

10、工具 哮 喘 控制 目 标 预 防 诱 因重 要 性 人数构成比（）人数构成比（）人数构成比（）人数构成比（）人数构成比（）人数构成比（）人数构成比（）人数构成比（）教育组73 73100.0 6183.66690.4 73100.0 72 98.6 68 93.2 7197.3 67 91.8 对照组30 20 66.76 20.0 13 43.3 19 63.3 2686.7620.0 18 60.0 2376.7x2值 2328 3778 2637 2625 425 5624 2226 440 P值0.01 0.01 0.01 0.01 0.05 0.01 0.01 0.05 0.01

11、0.01 0.05 .表3 activities taken by patients 分组 调查人数 曾经坚持3个月以上吸入激素 仍然坚持吸入激素 吸入方法正确 拥有峰速仪 经常监测峰流速 个人记录峰流速值 峰流速记录供医生参考 注意预防哮喘诱因 人数 构成比（） 人数 构成比（）人数 构成比（）人数 构成比（）人数 构成比（）人数 构成比（）人数 构成比（）人数 构成比（）教育组 73 69 94.5 60 82.272 98.6 57 78.1 35 47.9 31 42.5 25 34.2 67 91.8 对照组 30 11 36.7 1736.726 86.7 8 26.7 1 3.3

12、 13.3 13.3 23 76.7 x2值 37.76 20.58 425 24.14 1861 1520 1077 4.40 P值 0.01 0.01 0.05 0.01 0.01 0.01 0.01 0.05 0.01 0.01 0.01 0.01 0.05 0.01 .表5 life quality evaluation for patients of Asthma 分 组 调查人数 活动受限（60） 哮喘症状（40） 心理状况（30） 对刺激原反应（25） 对自身健康的关心（20） 哮喘生命质量总分（175） 教育组 56 506 373 273 242 173 15512 对照组

13、30 4410 316 235 214 134 13224 t值 333 533 494 326 492 517 P值 0.01 0.01 0.01 0.01 0.01 0.01 .表6 hospital medical resources using by patients 分组 调查人数 非 预 约 门 诊 就 医 急 诊 就 医 住 院 人数 构成比（） 人均次数 人数 构成比（）人均次数人数 构成比（）人均次数教育组 56 9 16.1 0.51.7 4 7.1 0.20.6 2 3.6 0.10.3 对照组 30 20 66.7 2.12.8 12 40.0 0.60.9 413.3

14、 0.20.7 t值 4.82 3.55 1.69 x2值 2238 1393 156 P值 0.01 0.01 0.01 0.05 0.05 .In 2006表7 patients knowledge & information level on Asthma 分组 例数 认为哮喘本质 是气道慢性炎症性疾病 例（） 认为持续期每日均应规律使用的一线药物是吸入型糖皮质激素 例（） 认为哮喘可以被长期控制 例（） 教育组 100 95(95%) 95(95%) 95(95%) 对照组427272(64%) 182(43%) 316(74%) x2值 37.543 89.146 20.805 P值

15、 0.01 0.01 0.01 .表8 activities taken by patients for Asthma control 分组例数曾接受过肺功能测定例（） 拥有医生制定的长期治疗计划例（） 每日坚持规律吸入糖皮质激素例（） 拥有呼气峰流速仪例（） 每日监测呼气峰流速例（） 曾吸烟人数例（）12(12%)94(22%)5.2550.05已戒烟人数例（） 教育组 100 93(93%) 91(91%) 82(82%) 42(42%) 11(11%) 12(12%) 7(58%) 对照组 427 339(79%) 166(39%) 232(54%) 80(19%) 21(5%) 94(

16、22%)29(31%) 2值 333 10.155 88.109 25.755 24.650 5.255 5.057 P值 0.01 0.01 0.01 0.01 0.01 0.05 0.05 .表9 the condition control 分组 例数 哮喘控制测试（ACT）评分20分例（） 过去一年中因哮喘加重住院例（）过去一年中因哮喘加重看急诊例（） 在职患者例（） 过去一年中因哮喘误工例（） 教育组 100 85(85%) 4(4%) 18(18%) 49(49) 10(20) 对照组 427 159(37%) 99(23%) 136(32%) 137(32) 76(55) 2值 3

17、33 74.345 19.431 7.515 4.678 P值 0.01 0.01 0.01 0.01 0.05 . published in 2005, the Asthma, never say goodbye-from the Asthma patients . on Oct.11st, 2007 the Ministry of Public Health Certificated our tries on Asthma education . after years exploration, it is the Asthma itself that is the very enemy

18、of mine, the concentration should not be the doctor-patient resistance. . unregulated Asthma treatment cost more, even sometimes soaring. . our exploration will reduce our cost significantly and very meaningful for our whole society. . Asthma control is significant for our country . patients should behavior more actively, then the medical itself would be really meaningful! . We need new doctor-patient relationship. Changing the model of medical service to pro