【摘要】：目的:評估醫(yī)養(yǎng)護一體化服務模式下社區(qū)失能老人現(xiàn)存的健康問題及其對每個健康問題的認知、所采取的行為、健康問題的狀態(tài)的變化。方法:1.調查方法:本研究采取便利抽樣的方法,運用國際標準化護理語言—奧馬哈系統(tǒng)對杭州市某社區(qū)衛(wèi)生服務中心簽約醫(yī)養(yǎng)護一體化服務的80名失能老人現(xiàn)存的健康問題及其每個健康問題的認知、行為、狀態(tài)進行評估。第一次評估為失能老人簽約但未接受醫(yī)養(yǎng)護一體化服務時,之后評估每兩個月一次,共四次,每次評估時間約1 h、持續(xù)時間為六個月。同時,為了使評估資料更加全面,本研究在完成評估后增加一個開放性問題:根據(jù)您自身的情況,您認為您主要的健康問題有哪些?2.統(tǒng)計學方法:本研究使用描述性分析(均數(shù)、標準差、頻數(shù)、構成比)描述社區(qū)失能老人的一般信息,現(xiàn)存的健康問題,社區(qū)失能老人現(xiàn)存的每個健康問題的認知、行為、狀態(tài)情況。社區(qū)失能老人現(xiàn)存的健康問題的認知、行為、狀態(tài)的變化情況采用Friedman檢驗(簡稱M檢驗)。結果:1.第一次評估為社區(qū)失能老人剛簽約醫(yī)養(yǎng)護一體化服務時,發(fā)現(xiàn)社區(qū)失能老人存在(12.7±3.13)個健康問題,第二次評估時發(fā)現(xiàn)(12.3±2.89)個健康問題,第三次評估時發(fā)現(xiàn)(12.2±2.74)個健康問題,第四次評估時發(fā)現(xiàn)(12.2±2.75)個健康問題。2.四次評估中共同存在的常見健康問題(發(fā)生率≥50%的健康問題):環(huán)境領域為住宅問題;心理社會領域為社交問題和精神健康問題;生理領域為視覺問題、口腔衛(wèi)生問題、認知問題、神經(jīng)-肌肉-骨骼功能問題;健康相關行為領域為身體活動問題和個人照顧問題。3.隨著時間的推移,簽約醫(yī)養(yǎng)護一體化服務的社區(qū)失能老人在社交問題、精神健康問題、口腔衛(wèi)生問題、循環(huán)問題的認知得分增加有統(tǒng)計學意義(P0.05),循環(huán)問題的行為得分增加有統(tǒng)計學意義(P0.05),社交問題、神經(jīng)-肌肉-骨骼功能問題、循環(huán)問題的狀態(tài)得分增加有統(tǒng)計學意義(P0.05)。結論:1.簽約醫(yī)養(yǎng)護一體化服務的社區(qū)失能老人的健康問題多(在42個健康問題中,平均每名失能老人存在約13個健康問題),社區(qū)失能老人的常見健康問題的行為和狀態(tài)較認知差。2.醫(yī)養(yǎng)護一體化服務可能有助于改善社區(qū)失能老人的社交問題、精神健康問題、口腔衛(wèi)生問題、循環(huán)問題的認知,循環(huán)問題的行為以及社交問題、神經(jīng)-肌肉-骨骼功能問題和循環(huán)問題的狀態(tài)。而尚未發(fā)現(xiàn)醫(yī)養(yǎng)護一體化服務對社區(qū)失能老人其他健康問題的改善效果。
[Abstract]:Objective: to evaluate the existing health problems of the elderly with community disability and the changes of their cognition, behavior and state of health problems under the model of integrated medical and conservation services. Method 1: 1. Methods of investigation: this study adopts a convenient sampling method, An international standardized nursing language-Omaha system was used to evaluate the existing health problems and the cognition, behavior and status of 80 disabled elderly people who were contracted by a community health service center in Hangzhou. The first assessment was for the disabled but did not accept the integrated medical care service, and then every two months, a total of four times, each assessment time is about 1 hour, the duration is six months. At the same time, in order to make the assessment more comprehensive, this study adds an open question to the completion of the evaluation: what do you think are your major health problems based on your own situation? 2. Statistical methods: this study uses descriptive analysis (mean, standard deviation, frequency, composition ratio) to describe the general information about the disabled elderly in the community, the existing health problems, the cognition and behavior of each of the existing health problems of the disabled elderly in the community. Status. The changes of cognition, behavior and state of the existing health problems of the disabled elderly in the community were tested by Friedman test (M test for short). The result is 1: 1. In the first assessment, when the community disabled people signed up for the integrated medical care service, it was found that there were (12.7 鹵3.13) health problems in the community disabled elderly, (12.3 鹵2.89) health problems in the second assessment, and (12.2 鹵2.74) health problems in the third assessment. The fourth assessment found (12.2 鹵2.75) health problems. Common health problems common in the four assessments (health problems with a prevalence rate of more than 50 per cent): residential problems in the environmental field; social and mental health problems in the psychosocial field; visual and oral health problems in the physical field, Cognitive problems, neuro-muscle-bone function problems; health-related behavioral issues: physical activity problems and personal care problems. Over time, the community incapacitated elderly signed up for an integrated medical care service had social problems, mental health problems, oral health problems, The cognitive scores of circulatory problems increased significantly (P0.05), the behavioral scores of circulatory problems increased significantly (P0.05), social problems, neuromusculoskeletal function problems and circulatory problems state scores increased significantly (P0.05). Conclusion 1. The health problems of the disabled elderly in the community were more than those in the community with integrated medical and maintenance services (of 42 health problems, there were about 13 health problems per disabled elderly on average), and the behavior and state of the common health problems of the disabled elderly in the community were worse than that in the community. 2. Integrated health care services may help improve social problems, mental health problems, oral health problems, circulatory problems, behavior of circulatory problems, and social problems in the community. The state of neuromuscular-skeletal problems and circulatory problems. However, the effect of integrated medical and maintenance services on other health problems of disabled elderly in the community has not been found.
【學位授予單位】：杭州師范大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.2

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