Study On Self-management Of Elderly Patients With Percutaneous Coronary Intervention Based On Chronic Illness Trajectory Model

Research purpose:This study adopts a research method mixed quantitative research with qualitative research based on Chronic Illness Trajectory Model,in order to investigate the current situation and influencing factors of self-management of elderly percutaneous coronary intervention patients and explore the self-management experience of disease-related behavior,self-concept behavior and daily life behavior of patients in the in-hospital rehabilitation period and out-hospital early rehabilitation period,finally grasp the key points of self-management of elderly percutaneous coronary intervention patients in the in-hospital rehabilitation period and out-hospital early rehabilitation period and provide theoretical basis for the formulation of systematic self-management strategies for elderly percutaneous coronary intervention patients under Chronic Illness Trajectory Model.Materials and Methods:This study has two parts:The first part is cross-sectional study.A total of 302 elderly patients with percutaneous coronary intervention in a third class hospital in Chengdu from December2020 to September 2021 were included,including 152 patients of in-hospital rehabilitation period and 150 patients of out-hospital early rehabilitation period.Patients in two different disease stages were investigated by coronary heart disease self-management scale.Firstly questionnaire are entered into Epi Data 3.1 and then exported to SPSS 26.0 for data analysis.General demographic data and disease-related clinical data are described by frequency and constituent ratio;in one-way analysis,Kruskal-Wallis test is used,multiple comparisons are made at the same time;ɑ= 0.1 as the elimination level of independent variables,the eligible variables in one-way analysis are taken as independent variables(multiple classification variables are set as virtual variables),and the total score of self-management is divided into dependent variables.Multiple linear regression analysis is carried out to explore the influencing factors of self-management behavior.The second part is qualitative study.The interviewees are selected through purposeful sampling method.Based on Chronic Illness Trajectory Model,semi-structured and personal in-depth interviews are used to explore the self-management experience of disease-related behavior,self-concept behavior and daily life behavior of elderly percutaneous coronary intervention patients during in-hospital rehabilitation period and out-hospital early rehabilitation period.When the newly collected data can no longer produce new topics,the sample size reaches saturation,finally there are 15 in-hospital rehabilitation period interviewees and 13out-hospital early rehabilitation period interviewees.Within 24 hours after the end of each interview,the researcher transcribe the recorded data word by word and sentence by sentence.All information related to the interviewee’s name,address,work unit and other personal information were treated with privacy.The data were analyzed with Nvivo 12 software and Colaizzi analysis method.Result:1 quantitative research’ results1.1 The self-management scoring indicators of elderly patients with percutaneous coronary intervention in the in-hospital rehabilitation period(50.49%)and out-hospital early rehabilitation period(50.71%)are at a low level.The scoring indicators of each dimension of self-management scale are from high to low: emotional cognitive management(71.05%,76.17%),daily life management(70.67%,73.8%)and disease medical management(34.37%,31.73%).According to relevant research,self-management scale can be divided into seven specific dimensions,the scoring indicators of in-hospital rehabilitation period and out-hospital early rehabilitation period from high to low are: bad hobby management(76.88%,77.77%),emotional cognition management(71.05%,76.17%),general life management(64.61%,69.87%),treatment compliance management(37.46%,37.96%),disease knowledge acquisition management(36.21%,34.03),emergency management(34.78%,32.49%),and symptom management(29.44%,23.63%).1.2 The results of multiple linear regression analysis shows: gender,hypertension and course of coronary heart disease are the influencing factors of self-management behavior in the in-hospital rehabilitation period,elderly percutaneous coronary intervention patients have hypertension or longer course of coronary heart disease or male,they likely have better self-management behavior;In out-hospital early rehabilitation period,medical insurance type and previous stent implantation history are the influencing factors of self-management behavior,elderly percutaneous coronary intervention patients self paid or had three stent implantation histories have better self-management behavior.2 qualitative research’ resultsBased on the three dimensions of Chronic Illness Trajectory Model,self-management experience of elderly patients with percutaneous coronary intervention in the in-hospital rehabilitation period and out-hospital early rehabilitation period was extracted respectively.2.1 In-hospital rehabilitation period:(1)Disease-related behavior: extremely lack of disease-related knowledge,starting to reflect on the disease,actively cooperate with doctors for treatment;(2)Self-concept behavior: lack of self-concept;(3)Daily life behavior: decide to adjust daily life behavior.2.2 Out-hospital early rehabilitation:(1)Disease-related behavior: insufficient attention to disease rehabilitation and health care;diversity of access to disease management information coexists with complexity of information.;(2)Self concept behavior: gradually accept disease and self;(3)Daily life behavior: family members play the management function of daily life collectively;insufficient ability to manage internal pressure.Conclusions:1.Self-management behavior of elderly patients with percutaneous coronary intervention in the in-hospital rehabilitation period and out-hospital early rehabilitation period is at a low level,disease medical management is the lowest.In the in-hospital rehabilitation period,the influencing factors of self-management behavior are gender,hypertension and the course of coronary heart disease;In the out-hospital early rehabilitation period,the influencing factors of self-management behavior are medical insurance type and previous stent implantation history.2.Elderly patients with percutaneous coronary intervention have different self-management experiences in the in-hospital rehabilitation period and out-hospital early rehabilitation period,the self-management problem of patients in-hospital rehabilitation period is the lacking self-concept,and the self-management problem of out-hospital early rehabilitation period is the weakening of disease self-management consciousness and heavy psychological burden.3.Medical staff should take full account of the self-management differences of elderly patients with percutaneous coronary intervention during in-hospital rehabilitation period and out-hospital early rehabilitation period from aspects of objective factors and patients’ s subjective experience,and make targeted adjustments and interventions to improve the self-management level of patients.