Mahmood D, Dicianno B, Bellin M
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Child Care Health Dev. 2011 Nov;37(6):861-5. doi: 10.1111/j.1365-2214.2011.01299.x.
In this multicentre cross-sectional study we aimed to identify whether self-management ability and healthcare service delivery factors were related to preventable conditions [urinary tract infections (UTIs), pressure ulcers] and healthcare utilization [emergency room (ER) visits, hospitalizations] specifically in a sample of young adults with myelomeningocele.
Spina bifida is one of the most common congenital birth defects, affecting over 166,000 individuals living in the USA. Participants completed a questionnaire comprised of a self-report measure of healthcare services (Patient Assessment of Chronic Illness Care), recent healthcare utilization and preventable medical conditions. A structured clinical interview [Adolescent Self-Management and Independence Scale 2 (AMIS)] was administered to assess self-management. Multiple linear regression models were run to explore individual and combined effects of the AMIS, Patient Assessment of Chronic Illness Care, condition severity variables (shunted hydrocephalus, lesion level) and demographic factors in explaining variability in ER visits, hospitalizations, UTIs and pressure ulcers.
Higher number of UTIs were associated with no history of shunting, lower educational levels, higher employment levels and lower AMIS scores (adjusted R(2) = 0.774, P = 0.002). Higher number of ulcers was associated with higher motor level and higher educational level (adjusted R(2) = 0.378, P = 0.017). Higher number of hospitalizations was associated with higher number of wounds and lower AMIS scores (adjusted R(2) = 0.544, P = 0.012). A significant model for ER visits was not identified.
Initiatives aimed at improving self-management skills or providing support for skin and bladder care may be warranted for those with high levels of motor impairment or lower educational levels. Better detection of wounds may be seen in those with higher employment levels. Spina bifida is a complex condition, but one whose most prevalent concomitant secondary conditions may be preventable through simple measures that improve self-management and through health educational initiatives targeted to specific patient groups.
在这项多中心横断面研究中，我们旨在确定自我管理能力和医疗服务提供因素是否与可预防疾病[尿路感染（UTI）、压疮]以及医疗利用情况[急诊室（ER）就诊、住院]相关，特别是在患有脊髓脊膜膨出的年轻成人样本中。
脊柱裂是最常见的先天性出生缺陷之一，影响着美国超过16.6万人。参与者完成了一份问卷，其中包括医疗服务的自我报告测量（慢性病护理患者评估）、近期医疗利用情况和可预防的医疗状况。进行了结构化临床访谈[青少年自我管理与独立量表2（AMIS）]以评估自我管理能力。运行多元线性回归模型，以探讨AMIS、慢性病护理患者评估、病情严重程度变量（分流性脑积水、病变水平）和人口统计学因素在解释急诊室就诊、住院、UTI和压疮变异性方面的个体和综合影响。
UTI次数较多与无分流病史、教育水平较低、就业水平较高和AMIS得分较低相关（调整后R² = 0.774，P = 0.002）。溃疡数量较多与运动水平较高和教育水平较高相关（调整后R² = 0.378，P = 0.017）。住院次数较多与伤口数量较多和AMIS得分较低相关（调整后R² = 0.544，P = 0.012）。未确定急诊室就诊的显著模型。
对于运动障碍程度较高或教育水平较低的人，可能有必要采取旨在提高自我管理技能或为皮肤和膀胱护理提供支持的举措。就业水平较高的人伤口检测可能更好。脊柱裂是一种复杂的疾病，但通过改善自我管理的简单措施以及针对特定患者群体的健康教育举措，其最常见的伴随继发性疾病可能是可预防的。
