| Research PurposeThe study was to investigate the quality of life in patients with chronic heart failure in the community and its influencing factors by combined quantitative study with qualitative study. Aiming at different influencing factors, the family doctor responsibility system was used in the in patients with chronic heart failure in the community. Effectiveness and accessibility of the new management mode were appraised with several indexes. These indexes included quality of life,6-minute walking test distance, mean monthly medical expenses, etc.Methods1.116patients with chronic heart failure, who were undergoing treatment in the community health service center of Taiyuan during January to December2010and were confirmed by a third-grade class-A hospital, were recruited in the study. The patients were evaluated with self-developed demographic questionnaire and the quality of life questionnaire of Minnesota in heart failure, and then influencing factors were analyzed.2. A purposive sampling of10patients from the first part study was conducted on a semi-structure interview. Phenomenology method was used to collect data. Six themes of influencing factors of the quality of life in patients with chronic heart failure in the community were concluded.3. A total of100cases of chronic heart failure were recruited with the time sequence of seeing doctor. Divided100patients into the observation group and control group randomly. There were50cases in the each group. Routine diagnosis and treatment were used in the control group, while the family doctor responsibility system was used in the observation group when they were accepting the routine diagnosis and treatment. The quality of life,6-minute walking test distance,mean monthly medical expenses and the relevant situation were evaluated with self-developed demographic questionnaire and questionnaire of Minnesota in heart failure at12-month after the baseline survey.4. All the data obtained in the field investigation were statistically analyzed by computer with the software Excel2003and SPSS13.0for windows. Descriptive statistics, t-test, chi-square test, rank test and multiple linear stepwise regression were performed.Results1. The quality of life in patients with chronic heart failure in the communityThe total quality of life in patients with chronic heart failure in the community of Taiyuan was better than average. 2. Influencing factors related the quality of life in patients with chronic heart failure in the communityThe quality of life in patients with chronic heart failure in the community was influenced by factors including gender, character, family history, carer, exercise, drug types and occupational status. Female patients, not outgoing character, family history of heart failure, being at work, cared by children or others instead of spouse, the less exercise, the more drug types, the worse of life quality of patients were.3. Six themes of influencing factors of the quality of life in patients with chronic heart failure in the community(1) Recognition to the quality of life;(2) Physical symptoms;(3) Self-government skills;(4) Negative emotions, such as pessimism and depression;(5) Degree of family support;(6) Accessibility and continuity of medical service.4. Comparison of the quality of life between two groups before and after studyAfter12months, the quality of life in observation group was significantly better than that of in control group,(physical quality of life score,P<0.01.emotional quality of life score,P<0.05. total quality of life score,P<0.01.)5. Comparison of use of medications between two groupsAfter12months, use of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonist(ACEI/ARB) in observation group was significantly better than that of in control group (P<0.05). Achieved the target dose of ACEI/ARB and β-blocker in observation group was significantly higher than that of in control group. There was no enough evidence to say that use of β-blocker and diuretics in two groups was significantly (P>0.05)6. Comparison of6-minute walking test distance between two groups before and after studyAfter12months,6-minute walking test distance in observation group was significantly higher than that of in control group (P<0.05)7. Comparison of change in knowledge and action between two groupsAfter12months, passing grade of knowledge about heart failure, the compliance of patient to ordered drug therapy, reducing salt intake, self-monitoring of pulse rate and moderate exercise in observation group was significantly improved than that of in control group.But There was no enough evidence to say that self-monitoring of blood pressure,smoking and drinking in two groups was significantly (P>0.05) 8. Comparison of medical treatment frequency between two groupsReadmission case-times of the deterioration of heart failure (P<0.05), case-times of emergency patients with chronic heart failure (P<0.01) in observation group were significantly lower than that of in control group. Case-times of average patients with chronic heart failure in observation group were significantly higher than that of in control group (P<0.01)9. Comparison of mean monthly medical expenses between two groupsMean monthly medical expenses in observation group were significantly lower than that of in control group (P<0.05)10. Comparison of the first visit at community medical institution between two groupsElecting the first visit at community medical institution in observation group was significantly higher than that of in control group (P<0.05)Conclusion1. The total quality of life in patients with chronic heart failure in the community of Taiyuan was better than average.2. The quality of life in patients with chronic heart failure in the community was influenced by factors including gender, character, family history, carer, exercise, drug types and occupational status.3. Six themes of influencing factors of the quality of life in patients with chronic heart failure in the community were concluded, including recognition to the quality of life, physical symptoms, self-government skills, negative emotions, such as pessimism and depression, degree of family support, accessibility and continuity of medical service.4. Medical staff in the community should fully consider these influencing factors. Aiming at different influencing factors, family doctor responsibility system of multidisciplinary collaboration should developed in supervision with chronic heart failure in the community building contractual relationship with patients; providing professional, accessibility, continuity of medical service; encouraging family members provide further support to patients wound improve self-government skills and the quality of life in patients with chronic heart failure.5. The family doctor responsibility system can improve the quality of life in patients with chronic heart failure in the community, treatment adherence, self-government skills, drug-used rate and the target dose, ameliorate physiological function and exercise endurance capacity reduce case-times of emergency and readmission case-times of the deterioration of heart failure, save hospital cost, improve acceptability of community medical institution. |
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