The Study Of Quality Of Life Evaluation And Patient's Compliance Of Bronchial Asthma Patients In Out-patient Clinic

In the wake of resolution of medical model,quality of life already have become the critical parameter of appreciation drug and other therapeutic regimen,the comprehensiveness index to reflect the effect of disease and therapeutic measure to body,psychological and social activities. Patient's compliance of asthma patients is one of the significant influencing factors to therapeutic efficacy.Therefore,investigating the influence of patients compliance to quality of life,pulmonary function,content of mediators of inflammation,evaluation the effectiveness of patient's health education to increase patient's compliance,accordingly improving life quality of asthma patients,are significant to provide theory evidence and clinical guidance for making the mode of asthma education management.The research includes two methods of cross-sectional study and follow-up investigation, objective(1)the level of life quality of asthma patients and risk factors of quality of life;(2) influence of patient's compliance to inhale hormone therapy,includes three parts,quality of life,pulmonary function,content of mediators of inflammation in serum and sputum;(3)According to the reason of bad patient's compliance and demand of patients,planning and practicing the mode of asthma education management,evaluating effectiveness of intervention.PARTâ… Study on evaluating quality of life of asthma patients and risk factors Sampling and methods128 bronchial asthma patients aged 14-80 years were tested with proportional in out-patient clinic of first affiliated hospital of ShanXi medical university,according with Chinese guideline of prevention and management established by Chinese Medical Association,simultaneously course of disease was more than one year;being chronic persistent period severity gradeâ…¡and more;agreeing with using long-term control medication including inhaled cortex hormone;using inhaled cortex hormone more than one month.Using questionnaire of general state of health, ACT^TM,quality of life and patient's compliance on cross-sectional study.Multiple databases were established based on EPIDATA,SPSS12.0 software was used in statistical analysis.Used t-test or ANOVA,Pearson correlation analysis,multivariant stepwise regression analysis, Scale-reliability analysis and principal component analysis.The sensitivity and specificity of the screening instrument was more than 95%.Results1.The score of life quality,ACT^TM,patient's compliance in different sex,the score of life quality in different age group,the score of life quality,ACT^TMin different education,the score of life quality in different course of disease,the score of life quality in different income,the score of life quality in different habitation,the difference have statistical significance.2.The study of dependability with patient's compliance,ACT^TMand quality of lifeThe coefficient correlation of patient's compliance has the statistical significance with the domain of limitation of activity(LOM)(r=0.365),avoidance stimulus(r=0.559),symptoms of asthma(SOA)(r=0.426),psychological emotion(EM)(r=0.477),stimulus reaction(r=0.163) and worry about disease(r=0.447).The coefficient correlation of cognition has the statistical significance with patient's compliance(r=0.412),the domain of limitation of activity(r=0.360),avoidance stimulus(r=0.340).The coefficient correlation of patient's compliance has the statistical significance with ACT^TM(r=0.387),The coefficient correlation of ACT^TMhas the statistical significance with the domain of limitation of activity(r=0.464),avoidance stimulus (r=0.755),symptoms of asthma(r=0.586),psychological emotion(r=0.661),stimulus reaction (r=0.426),worry about disease(r=0.684)and the score of life quality(r=0.367).Moreover, all of them are positive correlation.3.The study of influential factor analysis on quality of lifeAmong influential factors on quality of life,the contribution of patient's compliance is max, Beta=0.241,next is course of disease,Beta=-0.223,and education,Beta=0.213.Influential factors on the domain of limitation of activity,the contribution of course of disease is max,Beta=-0.298, next is education,Beta=0.242.Influential factors on the domain of avoidance stimulus,the contribution of patient's compliance is max,Beta=0.249,next is education,Beta=0.226. Influential factors on the domain of symptoms of asthma,the contribution of patient's compliance is max,Beta=0.314,next is course of disease,Beta=-0.280.Influential factors on the domain of psychological emotion,the contribution of patient's compliance is max,Beta=0.248,next is habitation,Beta=0.221.Influential factors on the domain of worry about disease,the contribution of education is max,Beta=0.289,next is course of disease,Beta=-0.198.4.The analysis of validity and reliability in index about quality of life of asthma patientThe coefficient correlation of test-retest reliability is between 0.346-0.590;split-half reliability R=0.8215;Cronbach's is between 0.6327-0.9485.Criterion-related validity is 0.852;using principal component analysis extracts six principal constituents from 33 items of 6 domains,and the accum contribution is 70.194%.Conclusions1.There is a great deal of influence factors to quality of life of asthma patients,principally age,sex,education,course of disease,habitation,income and so on.2.Among the influence factors,patient's compliance,course of disease and education of patients have the comparatively large contribution,education and course of disease are objectively present,and can not be influenced,however patient's compliance can be supplied. intervention,accordingly life quality is improved.3.The validity,reliability and feasibility of index about quality of life is according with requirement,can be used in follow investigate and discuss.PARTâ…¡A follow-up investigation on patient's compliance and therapeutic efficacy of glucocorticosteroidSampling and methods20 bronchial asthma patients,diagnosing and staging are both according with Chinese guideline of prevention and management established by Chinese Medical Association. Simultaneous select 8 health without anaphylactic disease,cardiac and pulmonary disease as control group.Detecting index include pulmonary function,patient's compliance,quality of life,ACT,and density of mediators of inflammation:TNF-α,IFN-γ,IL-6,IL-10 of serum and sputum,detected with enzyme linked immunosorbent assay(ELISA).Determinations have four times in all,prior treatment,after therapy 1 month,3 months and 6 months.SPSS12.0 software was used in statistical analysis.Used Pearson correlation analysis,multi variable repeated measures.Results1.The effect of patient's compliance to pulmonary functionThe measure of FEV₁%,PEF%and FEV₁/FVC in four times,the difference have statistical significance,the value increases gradually.The interaction of measurements with patient's compliance of four times has statistical significance.After therapy 1 month good compliance patients' FEV₁%,PEF%has statistical significance with therapy 3 months and 6 months; FEV₁/FVC of therapy 3 months has statistical significance with 1 month,6 months with 3 months.2.The effect of patient's compliance to quality of life and ACTThe differences of quality of life and ACT have statistical significance in four times.The interaction of measurements with patient's compliance of four times has statistical significance. The main effect of patient's compliance with quality of life and ACT has statistical significance. After therapy 1-month good compliance patients' ACT has statistical significance with prior treatment,therapy 3 months has statistical significance with 1 month,6 months with 3 months. The score of quality of life,limitation of motion,symptoms of asthma in therapy 3 months has statistical significance with prior treatment,1 month,6 months;Avoidance stimulus,stimulus reaction in 3,6 months has statistical significance with prior treatment and 1month;Worry about disease in 1,3,6 months has statistical significance with prior treatment,6 months with 1 month.3.The effect of patient's compliance to density of mediators of inflammation in serum and sputumThe density of IL-6,IL-10 in serum and sputum increase with the time of therapy,the density of IFN-γ,TNF-αin serum and sputum decrease.The density of IL-6,IL-10 increase after 1 month in serum,the density of IFN-γdecrease after 3 months in serum;The density of TNF-αdecrease after 1 month in serum.The density of IL-6 increases after 1 month in sputum.The density of IL-10 increase at 3 months,do not change after 3 months in sputum.The density of IFN-γ,TNF-αdecrease after 3 months in sputum.4.The correlation analysis of mediators of inflammation with pulmonary function and quality of lifeThe coefficient correlation has statistical significance of the density of IL-10 in serum with ACT at 1,3,6 months(r=0.639,r=0.660,r=0.665);The coefficient correlation has statistical significance of the density of IFN-γin serum with FEV₁%at 1,6 months,(r=0.650,r=0.669). The coefficient correlation has statistical significance of the density of IL-6 in sputum with FEV₁/FVC at 3,6 months(r=0.588,r=0.595).The coefficient correlation has statistical significance of the density of IFN-γin sputum with ACT at 6 months(r=0.607);The coefficient correlation has statistical significance of the density of TNF-αin sputum with worry about disease at 3,6 months(r=-0.578,r=-0.743),with ACT at prior treatment(r=-0.649),are negative correlation.Conclusions1.With the lasting of therapy time,compared to bad compliance group,pulmonary function,quality of life,asthma control level of good group improve greatly;The density of IL-6,IL-10 in serum and sputum rise comparatively,The density of IFN-γ,TNF-αdecrease greatly.All in all the therapeutic efficacy of good compliance group has an advantage than bad group.2.At 6 months of using budesonide,the mediators of inflammation both in serum and sputum change significantly,indicating the time of emerging predominance.3.The density of mediators of inflammation in serum and sputum increase or decrease with the change of pulmonary function,quality of life,asthma control level of patients.PARTâ…¢The investigation on evaluation of intervention effect of health education Data and methods95 bronchial asthma patients,according to randomization,separate them into two parties:control group and intervention group,being follow-up visited for at lest 6 months.Evaluate index are cognition level,AQL,ACT,patient's compliance and pulmonary function.All data were analyzed using Excel and SPSS12.0 software.Used t-test,ANOVA,chi square test and Pearson correlation analysis.Results1.20.0%patients have accepted asthma knowledge education.The way of obtain knowledge, 50.0%is medical member,specialist,35.0%is newspaper,broadcast,internet and handbook of asthma knowledge.In the reasons of bad compliance,discontinuation because of improve of condition is 45.7%,forgetting because of various kinds reason is 17.4%,the adverse reaction of long-term medication is 13.0%,Medication only during period of onset is 6.5%.2.The cognition level,patient's compliance,pulmonary function,AQL and ACT of intervention group has statistical significance with control group,the confidence and gratification to doctor of intervention group has statistical significance with control group.3.Coefficient correlation of cognition level with limitation of motion,avoidance stimulus and quality of life has statistical significance,and is positive correlation.ConclusionsThrough practicing intervention of health education,the score of cognition level,the confidence and gratification to doctor,patient's compliance,pulmonary function,quality of life and ACT have being raised predominantly.The better grasping cognition,the higher score of quality of life;the better patient's compliance,the higher score of quality of life.The demand to health education of asthma patients is exigent.Health education has significant meaning for raising patient's compliance,improving level of life quality,increasing pulmonary function of patients.