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温方圆, 杜光会, 田丰, 等. 患者门户系统在老年冠心病慢病远程管理中的应用及效果[J]. koko体育app 学报（医学版）, 2024, 55(2): 418-424. DOI:
引用本文: 温方圆, 杜光会, 田丰, 等. 患者门户系统在老年冠心病慢病远程管理中的应用及效果[J]. koko体育app 学报（医学版）, 2024, 55(2): 418-424. DOI:
WEN Fangyuan, DU Guanghui, TIAN Feng, et al. Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(2): 418-424. DOI:
Citation: WEN Fangyuan, DU Guanghui, TIAN Feng, et al. Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(2): 418-424. DOI: 🧸

患者门户系统在老年冠心病慢病远程管理中的应用及效果

Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease

  • 摘要:
    目的  探讨基于患者门户系统（PPS）建立的个人电子健康记录（PHR）和慢性病管理平台在老年冠心病患者的应用及对自护能力、应对方式及生活质量的影响。
    方法  选取2019年1月–2021年6月某三甲医院收治的532例老年冠心病患者为研究对象，随机分为研究组269例和对照组263例。对照组患者进行常规出院办理和随访，研究组患者基于PPS建立的PHR和慢性病管理平台进行出院办理和随访。管理6个月、12个月、18个月后应用自护能力测评表（ESCA）、医学应对问卷（MCMQ）、西雅图心绞痛问卷（SAQ）对两组患者的自护能力、应对方式、生活质量，分析管理效果进行评价。
    结果  管理前，两组患者的各量表得分差异无统计学意义。管理6个月、12个月、18个月后，两组患者的ESCA量表评分均高于管理前（P<0.05）；两组患者MCMQ量表中面对维度评分高于管理前（P<0.05），回避和屈服维度评分低于管理前（P<0.05）；两组患者SAQ量表评分均高于管理前（P<0.05）。管理6个月、12个月、18个月后，研究组的ESCA量表评分均高于对照组（P<0.05）；研究组的面对维度评分高于对照组，回避和屈服维度评分低于对照组（P<0.05）；研究组的SAQ量表评分均高于对照组（P<0.05）。研究组服药依从率为83.27%，高于对照组的69.96%（P<0.05）。研究组不良心血管事件发生率为4.09%，低于对照组的10.27%（P<0.05）。研究组急诊和再入院平均次数低于对照组（P<0.05）。研究组患者满意度评分高于对照组（P<0.05）。
    结论  基于PPS建立的PHR和慢性病管理平台可提高老年冠心病患者的就医便利性，有利于改善自护能力、应对方式和生活质量，管理效果良好。
     
    Abstract:
    Objective To investigate the application of personal health record (PHR) and chronic disease management platform established on the basis of patient portal system (PPS) in managing older adults with coronary heart disease and to examine the effect on patients' self-care ability, coping mode, and quality of life.
    Methods A total of 532 elderly patients with coronary heart disease were included in the study. All the participants enrolled were admitted to a tertiary-care hospital between January 2019 and June 2021. They were randomly assigned to the study group (269 cases) and the control group (263 cases). Patients in the control group were discharged with the routine discharge procedures and received the routine follow-up care. On the other hand, patients in the study group were discharged and followed up through the PHR and chronic disease management platform established on the basis of PPS. After 6 months, 12 months, and 18 months of patient management, the Exercise of Self-Care Agency (ESCA) Scale, Medical Coping Modes Questionnaire (MCMQ) and Seattle Angina Questionnaire (SAQ) were used to evaluate the patients’ self-care ability, coping mode, and quality of life, respectively. The patient management effects of the two groups were analyzed.
    Results Before the management programs started, there was no statistically significant difference in the scores for the scales between the two groups of patients. After 6 months, 12 months, and 18 months of patient management, the ESCA scores of both groups were higher than those before patient management started (P<0.05). Facing scores in the MCMQ of both groups were higher than those before patient management started (P<0.05), while the scores for avoidance and yielding were lower than those before patient management started (P<0.05). The SAQ scores of both groups were higher than those before patient management started (P<0.05). After 6 months, 12 months and 18 months of patient management, the ESCA scores of the study group were always higher compared with those of the control group (P<0.05). The facing score of the study group was higher, while the scores for avoidance and yielding were lower compared with those of the control group (P<0.05). The SAQ scores of the study group were higher compared with those of the control group (P<0.05). The medication compliance rate in the study group (83.27%) was higher than that in the control group (69.96%) (P<0.05). The incidence of adverse cardiovascular events in the study group (4.09%) was lower than that in the control group (10.27%) (P<0.05). The average times of emergency treatment and readmission in the study group were lower compared with those of the control group (P<0.05). The patient satisfaction score of the study group was higher compared with that of the control group (P<0.05).
    Conclusion The PHR and chronic disease management platform established on the basis of PPS can increase the convenient access to medical care among elderly patients with coronary heart disease, which is conducive to improving their self-care ability, coping mode, and quality of life. In addition, the patient management effect is good.
     
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