| Objective(s):Based on the transformation theory,the status and influencing factors of the treatment burden of patients with psoriasis vulgaris were analyzed,and the management plan of the treatment burden of patients with psoriasis vulgaris was constructed according to the health coach model,so as to explore the clinical ideas of reducing the treatment burden of patients,controlling the disease symptoms and improving the quality of life,and also to provide the basis for the progressive management of psoriasis.Methods:This study consists of three parts.The first part;Evaluate the current situation.(1)Investigation of the status quo of the treatment burden of patients with psoriasis vulgaris.Systematic evaluation and qualitative study of the treatment burden of patients with psoriasis vulgaris were conducted through literature retrieval.(2)Evaluate the practice environment of the management scheme.The second part:According to the previous research,combined with the best evidence summary,transformation theory,health coaching technology to conduct expert meeting method,to form the treatment of psoriasis vulgaris burden management program.Part three:effect evaluation.Interventions were made according to the treatment burden management protocol for psoriasis vulgaris.A total of 78 patients with psoriasis vulgaris treated in the dermatology department of our hospital from September 2020 to September 2021 were randomly selected and divided into 2 groups according to the random number table method,39 cases in the control group and 39 cases in the experimental group.Control group according to the dermatology general nursing routine and routine education,the experimental group according to psoriasis vulgaris burden management program intervention.Physiological indexes were recorded:triglyceride,total cholesterol,high density lipoprotein,blood glucose,uric acid and blood pressure.Lesions were scored by the psoriasis Area and Severity index(PASI).Behavioral effects were evaluated using the Morisky medication Compliance Questionnaire(MMAS-8)and Dermatology Quality of Life Index Questionnaire(DLQI).The psychological effects were evaluated by the Body Image Disorder Self-Rating Scale(SSBI),and the treatment burden was evaluated by the Chronic Disease Co-existing Treatment Burden Questionnaire(MTBQ).Results:1.Meta-analysis concluded that self-management of the disease is an effective way to alleviate the burden of disease treatment and the progressive management of the disease in patients with psoriasis vulgaris.The results of the qualitative study showed that patients have the demand of scientific management of the burden of treatment,and the management of the burden of treatment is also the guarantee of delaying the course of the disease.Evaluation of the practice environment: Through the evaluation of patient factors,cultural and social factors,organizational factors,economic factors and uncontrollable factors,the conclusion is that this research program can be applied in practice.Evidence summary results were divided into 6 aspects of oral medicine,external medicine,risk factors,living habits,physical exercise,biological agents,a total of 34 evidence.According to the results of the first part of the study,the expert meeting method combined with evidence summary,expert meeting results and health coaching technology to form the final burden management plan for psoriasis vulgaris treatment.2.There were no significant differences in gender,age,duration of illness,educational level,marital status,height,weight,smoking and drinking between the two groups(P >0.05).3.Indicators of treatment management burden: The comparison of physiological results between the two groups at different time points showed that P<0.05 in all groups except uric acid group was statistically significant,and it could be seen that the levels of triglyceride,high-density lipoprotein,systolic blood pressure and diastolic blood pressure in the intervention group had significant changes compared with the control group.Intra-group comparison showed that after 6 weeks of intervention,P > 0.05 for high density lipoprotein,total cholesterol,blood glucose and uric acid in the control group indicated no statistical significance,while P < 0.05 for all indicators in the intervention group indicated statistical significance.After 12 W of intervention,all the other indicators were statistically significant except that the high-density lipoprotein P > 0.05 in the control group indicated no statistical significance.Inter-group comparison of PASI score between the two groups at different time points showed no statistical significance in PSAI score between the two groups at the time of enrollment(P > 0.05),and P < 0.05 indicated statistical significance at 6W and 12 W after intervention.After 6 and 12 weeks of intervention,PASI scores in the intervention group showed a significant downward trend and were lower than those in the control group.There was no statistical significance at all time points,except for the control group(P > 0.05)at the 6W time point when the group was enrolled,and the rest were statistically significant(P < 0.05).The comparison between the two groups before intervention showed no statistical significance(P >0.05).After 6 weeks of intervention,scale scores of both groups decreased,but the decrease range of the intervention group was significantly greater than that of the control group,P < 0.05 indicated statistical significance.After 12 W of intervention,the scale score of the treatment group decreased continuously and the intervention group was lower than the control group,P < 0.05 indicated statistical significance.Intra-group comparison showed that there was no statistical significance except for the control group when the intervention time was 12 W,P > 0.05.In addition,P < 0.05 at each time point indicated statistical significance.4.Index of psychological burden: intra-group comparison: intra-group comparison between the control group and the Morisky group had no statistical significance at the time of enrollment(P > 0.05),while P < 0.05 at each time node of other scales had statistical significance.The changes before and after intervention group were obvious.5.Transformation burden index: intra-group comparison At the time of enrollment,the intra-group comparison in the control group and the Morisky group(P > 0.05)had no statistical significance.The score of Morisky medication compliance questionnaire6 W after intervention was higher in the control group than in the intervention group,but 12 W after intervention,the effect of the intervention group was far better than the control group.6.Communication burden index: Before intervention,there was no statistical significance between groups(P > 0.05),while the other two groups had statistical significance compared with all scales(P < 0.05).The improvement of quality of life in the intervention group was better than the control group.7.Use the analytic hierarchy process to obtain the weight of each indicator and the correlation between each indicator.According to the correlation and weight of each index,it can be seen that external medication management(0.1977),body image disorder(0.1360)and oral medication management(0.1196)are the three with the highest weight.As can be seen from the analysis results,there was no correlation between mental state and drug management(P > 0.05,r =0.342),other variables were correlated to varying degrees,and all variables were positively correlated.Bivariate Pearson test showed a strong correlation between treatment burden management and other plates(P < 0.05,r > 0.6),and quality of life and drug management,disease symptoms and drug management,disease symptoms and quality of life.Conclusion:1.Currently,there is no standardized plan for the treatment burden of patients with psoriasis vulgaris,and patients lack the ability to self-manage the disease.The qualitative interview showed that the treatment burden of psoriasis patients included the treatment management burden,the psychological burden,the transformation burden,the communication burden of 4 subject groups.2.Through literature analysis and expert interviews,the health coaching technology scheme for the treatment burden management of psoriasis patients was constructed.The process was complete and rigorous,and the scheme was scientific.3.This program can improve the treatment burden of patients with psoriasis vulgaris,compared with the traditional way of care,can be more effective,more quickly to reach the urgent requirements of patients to remove skin lesions,help patients as soon as possible from the transformation of disease-health,restore normal social life,reduce the psychological pressure of patients,improve the quality of life.4.The key monitoring indicators in the health coach management program for psoriasis vulgaris patients with the burden of treatment are oral medication management,external medication management,symptom burden,anxiety and depression,body image disorders,among which external medication and body image disorders account for a relatively high weight,and are correlated with a number of indicators,should be evaluated in the self-management. |
PDF Full Text Request