Deng Yuan, Xiong Ying, Ning Ping, Wang Xin, Han Xiao-Rong, Tu Guo-Fang, He Pei-Yu
Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
BMC Womens Health. 2022 May 2;22(1):143. doi: 10.1186/s12905-022-01726-w.
Granulomatous mastitis (GM) is a chronic inflammatory mastitis disease that requires long-term treatment and has a high recurrence rate. Case management has been proven to be an effective mechanism in assisting patients with chronic illness to receive regular and targeted disease monitoring and health care service. The aim of this study was to investigate the application of a hospital-to-community model of case management for granulomatous mastitis and explore the related factors associated with its recurrence.
This was a prospective study on patients with granulomatous mastitis based on a case management model. Data on demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate patients' adherence to medications. Logistic regression models were built for analysis of risk factors for the recurrence of granulomatous mastitis.
By October 2021, a total of 152 female patients with a mean age of 32 years had undergone the entire case management process. The mean total course of case management was 24.54 (range 15-45) months. Almost all the patients received medication treatment, except for one pregnant patient who received observation therapy, and approximately 53.9% of the patients received medication and surgery. The overall recurrence rate was 11.2%, and "high" medication adherence (RR = 0.428, 95% CI 0.224-0.867, P = 0.015) was significantly associated with a lower rate of recurrence, while the rate of recurrence with a surgical procedure + medication was higher than that with medication alone (RR = 4.128, 95% CI 1.026-16.610, P = 0.046).
A case management model for patients with granulomatous mastitis was applied to effectively monitor changes in the disease and to identify factors associated with disease recurrence. "Low" medication adherence was a significant risk factor for the recurrence of granulomatous mastitis. Patients treated with medication and surgery were more likely to experience recurrence than those treated with medication alone. The optimal treatment approach should be planned for granulomatous mastitis patients, and patient medication adherence should be of concern to medical staff.
肉芽肿性乳腺炎（GM）是一种慢性炎症性乳腺炎疾病，需要长期治疗且复发率高。病例管理已被证明是协助慢性病患者接受定期和有针对性的疾病监测及医疗服务的有效机制。本研究的目的是调查肉芽肿性乳腺炎的医院-社区病例管理模式的应用，并探索与其复发相关的因素。
这是一项基于病例管理模式的肉芽肿性乳腺炎患者前瞻性研究。收集并分析了人口统计学、临床和实验室信息、治疗方法、随访时间及复发情况的数据。采用8项Morisky药物依从性量表（MMAS-8）调查患者的药物依从性。建立逻辑回归模型分析肉芽肿性乳腺炎复发的危险因素。
截至2021年10月，共有152例平均年龄为32岁的女性患者完成了整个病例管理过程。病例管理的平均总疗程为24.54（范围15 - 45）个月。除1例接受观察治疗的孕妇外，几乎所有患者均接受了药物治疗，约53.9%的患者接受了药物及手术治疗。总体复发率为11.2%，“高”药物依从性（RR = 0.428，95%CI 0.224 - 0.867，P = 0.015）与较低的复发率显著相关，而手术 + 药物治疗的复发率高于单纯药物治疗（RR = 4.128，95%CI 1.026 - 16.610，P = 0.046）。
肉芽肿性乳腺炎患者的病例管理模式有效地监测了疾病变化并识别了与疾病复发相关的因素。“低”药物依从性是肉芽肿性乳腺炎复发的重要危险因素。接受药物及手术治疗的患者比单纯接受药物治疗的患者更容易复发。应为肉芽肿性乳腺炎患者规划最佳治疗方案，医务人员应关注患者的药物依从性。
