| Objection:1.Design and develop We Chat platform and We Chat mini program that provide continuous medical management for glaucoma patients outside the hospital.2.Discuss the management effect of case management mode based onWe Chat platform+We Chat mini program on out-of-hospital glaucoma patients.Methods:This research consists of two parts:1.Design and development of We Chat platform and We Chat mini program.(1)Literature Research Method:By searching domestic and foreign databases,relevant literature on the management of patients with glaucoma outside the hospital was collected to provide a theoretical basis for the research and development of We Chat platform and We Chat mini program.(2)Qualitative Research Method:Phenomenological research method in qualitative research was used to conduct semi-structured in-depth interviews with 7 patients with glaucoma and 3 clinicians,so as to understand and collect the needs of patients with glaucoma and clinicians on We Chat platform and We Chat mini program and development suggestions.The result of the previous needs survey is the framework,referring to the existing medical and health management We Chat platform and We Chat mini program on the market,creating a We Chat platform and determining its content outline,using We Chat mini program development tools to build the module structure of the We Chat mini program and function.(3)Preliminary experiment:12 glaucoma patients who were admitted to the Glaucoma Department of the Second Hospital of Jilin University in December 2019 were selected for preliminary experiment.According to the odd and even number of admission order,they were divided into experimental group(n=6)and control group(n=6).The control group adopted an out-of-hospital management mode of routine telephone follow-up,and the experimental group adopted a case management mode based on We Chat platform+We Chat mini program.Patients in the two groups were given out-of-hospital management for a period of 3 months after discharge,and patients were reminded to return to the hospital for re-examination at the first and third month after discharge.The two groups of patients were examined and evaluated by the same expert.According to the results of preliminary experiment,the research plan is judged to be feasible,and the contents and functions of each module of the We Chat platform and We Chat mini program are further improved and optimized based on the opinions of clinicians and patients.2.Application of case management mode based on We Chat platform+We Chat mini program in the management of out-of-hospital glaucoma patients.Patients who were diagnosed with primary glaucoma in the Glaucoma Department of the Second Hospital of Jilin University from March 2020to July 2020 were selected as the research objects.Collect general information about the patients.According to the odd and even number of admission order,they were divided into experimental group(n=30)and control group(n=30).The control group adopted the out-of-hospital management mode of routine telephone follow-up,while the experimental group adopted the case management mode based on We Chat platform+We Chat mini program.Inform the two groups of patients to return for visits at 1,3,and 6 months after discharge.Collect the results of each return visit and ask the patients to fill in relevant questionnaires.Finally,medication compliance,the rate of on-time follow-up visits,accumulated number of visits per capita,intraocular pressure,eyesight,visual filed,cognition of glaucoma disease,self-management ability,survival quality and satisfaction of the two groups of patients were analyzed and evaluated.Results:1.Design and development of We Chat platform and We Chat mini program.(1)The needs of glaucoma patients and clinicians for continuous out-of-hospital management can be summarized into three themes:(1)functional requirements;(2)performance requirements;(3)Safety requirements.Glaucoma patients and clinicians are more willing to use the case management mode based on the We Chat platform+We Chat mini program.(2)The We Chat platform designed and developed includes three modules:“The Class of Glaucoma”,“The Family of Glaucoma”and“Questionnaire Survey”.Enter“The Class of Glaucoma”to view historical tweets records,click“The Family of Glaucoma”to jump directly to the We Chat mini program interface,and click“Questionnaire Survey”to skip to the questionnaires filling page.The We Chat mini program designed and developed is divided into two login ports:the doctor login port and the patient login port:(1)The doctor login port:includes four modules:“Personnel Management”,“Check Symptom Pictures”,“Send Subscription Messages”and“Authorize”.(2)The patient login port:includes three modules:“Medication Sign-in”,“Exclusive Service”and“Personal Center”,among which the“Exclusive Service”module includes two modules:“The Class of Glaucoma”and“Chat Room”.The“Personal Center”module includes four modules:“Personal Information”,“My Medication”,“Check Results”,and“Questionnaire Survey”.2.Application of case management mode based on We Chat platform+We Chat mini program in the management of out-of-hospital glaucoma patients.(1)Medication compliance:At 1 month after discharge,there was no statistically significant difference(P>0.05)in medication compliance between the two groups.At 3 and 6 months after discharge,the patients in the experimental group had significantly higher medication compliance than the control group,and the differences were statistically significant(Z=-3.76,P<0.01;Z=-5.94,P<0.01).(2)The rate of on-time follow-up visits:At 1 and 3 months after discharge,there were no statistically significant differences in the rate of on-time follow-up visits between the two groups of patients(P>0.05).At 6 months after discharge,the patient in the experimental group had a significantly higher rate of on-time follow-up visits than that in the control group,and the difference was statistically significant(χ~2=5.71,P=0.02).(3)Accumulated number of visits per capita:At 3 and 6 months after discharge,the accumulated number of visits per capita in the experimental group(1.059;1.043)was lower than that in the control group(1.214;1.286).(4)Intraocular pressure:At 1,3,and 6 months after discharge,the intraocular pressure of the experimental group was significantly lower than that of the control group,the differences were statistically significant(t=-4.00,P<0.01;t=-6.21,P<0.01;t=-8.67,P<0.01).At 1,3,and 6 months after discharge,the intraocular pressure of the patients in the experimental group was significantly lower than that on the day of discharge,the differences were statistically significant(t=3.02,P<0.01;t=3.62,P<0.01;Z=-3.07,P<0.01).At 1 and3 months after discharge,there were no significant differences(P>0.05)in intraocular pressure between the control group and the day of discharge.At 6 months after discharge,the intraocular pressure of the patients in the control group was significantly higher than that on the day of discharge,the difference was statistically significant(t=-2.36,P=0.02).(5)The rate of improvement of eyesight:At 1,3 months after discharge,there were no statistically significant differences(P>0.05)in the rate of improvement of eyesight between the two groups of patients.At 6 months after discharge,the rate of improvement of eyesight in the experimental group was significantly higher than that in the control group,the difference was statistically significant(χ~2=3.879,P=0.049).(6)Visual filed:There were no statistically significant differences in the absolute value of the average visual field defect between the two groups at 3 and 6 months after discharge(P>0.05).At 6 months after discharge,there was no statistically significant difference in visual field progression events between the two groups of patients(P>0.05).(7)Cognition of glaucoma disease:At 1 month after discharge,there was no statistically significant difference in cognition of glaucoma between the two groups(P>0.05).At 3 and 6 months after discharge,the patients in the experimental group had significantly higher cognition of glaucoma than that in the control group,and the differences were statistically significant(Z=-4.45,P<0.01;Z=-5.71,P<0.01).(8)Self-management ability:At 6 months after discharge,patients in the experimental group were significantly higher than the control group in terms of functional health care,medical management of diseases,and total scores,and the differences were statistically significant(t=3.96,P<0.01;t=4.15,P<0.01;t=5.83,P<0.01).At 6months after discharge,there was no statistically significant difference in the life adjustment of patients in the two groups(P>0.05).(9)Survival quality:At 6 months after discharge,the experimental group was significantly higher than the control group in terms of symptoms,visual function and total score,and the differences were statistically significant(t=3.57,P<0.01;t=3.66,P<0.01)).At 6 months after discharge,there were no statistically significant differences in the three aspects of physical function,social activity,and mentality between the experimental group and the control group(P≥0.05).(10)Satisfaction:At 6 months after discharge,the satisfaction of patients in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P=0.011<0.05).Conclusion:1.Glaucoma patients and clinicians have a higher demand for a case management mode based on the We Chat platform+We Chat mini program.At the same time,the We Chat platform and We Chat mini program have a short development cycle,low cost,simple operation and rich functions.Medical staff can overcome the limitations of time and space to provide patients with professional information support,which is simple,economic and efficient,and has some clinical application value.2.The case management mode based on We Chat platform+We Chat mini program can not only improve the compliance behavior of glaucoma patients outside the hospital,but also reduce the number of unnecessary visits by patients.3.The case management mode based on We Chat platform+We Chat mini program can reduce the intraocular pressure of patients and maintain them for a longer period of time,improve the rate of improvement of patients’eyesight,and can improve cognition of glaucoma disease and self-management ability,improve survival quality and satisfaction. |
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