Effect of Continuing Motivational Interviewing on the Compliance of Diabetic Cataract Patients after Discharge from Day Surgery
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摘要:
目的 继续动机性访谈糖尿病性白内障患者，以得出其在日间手术出院后的复诊依从性的影响因素，并分析其应用效果。 方法 随机选取2018年1月至2019年1月上海交通大学医学院附属仁济医院眼科的糖尿病性白内障日间手术患者共108例，随机分为观察组与对照组，所有研究对象均接受仁济医院的健康教育，出院后对患者每个月都进行一次观察，不间断地观察6个月。对照组患者回访包含患者身体状况、服药情况，并且根据回访结果进行指导，对观察组患者采用继续动机性访谈的访谈方法，了解影响其出院后的复诊依从性的因素，并分析其应用效果，制定针对性继续访谈方案，护理人员负责访谈工作和健康教育。对比两组被研究者的复诊依从性。 结果 观察组患者应该复查知晓率为77.77%（42/54），对照组患者对复查的知晓率为38.89%（21/54）；观察组患者出院1～6个月复查依从性为74.07%、77.80%、81.48%、81.50%、83.30%和85.19%，对照组患者出院1～6个月复查依从性为38.89%、44.40%、48.15%、50.00%、53.70%和57.41%；在出院后的不良反应总发生概率中，观察组患者为9.26%，而对照组却高达37.04%，组间对比差异有统计学意义（P < 0.05）。 结论 继续动机性访谈可明显提高糖尿病性白内障患者日间手术出院后复诊依从性，出院后延续性访谈工作确保患者居家延续护理质量，降低患者不良反应发生率，具有很高的临床推广应用价值。 Abstract:Objective To determine the influencing factors of the compliance of patients with diabetic cataract after discharge from day surgery through continuing motivational interviews. Methods A total of 108 cases of patients with diabetic cataract surgery in the day were randomly selected from Renji Hospital Affiliated to Shanghai Jiaotong Nuiversity School of Medicine from January 2018 to January 2019, and were randomly divided into observation and control group. All patients accepted the hospital health education at the same time, and were continuously observed once a month for 6 months after discharge. The patients in the control group were reviewed about the health status and medication compliance, and were guided according to the review results. The patients in the observation group were treated by continuous motivated interview to understand the factors that affect the appointment compliance of patients after discharge, the application effect of continuous motivated interview was analyzed and the targeted continuous interview plan was formed. The nursing staffs were responsible for interview and health education. The follow-up compliance of patients in the two groups was compared. Results The awareness rate was 77.77%（42/54）in the observation group and 38.89%（21/54）in the control group. The patients in the observation group had 74.07%, 81.48 and 85.19% compliance at 1, 3 and 6 months after discharge, while the patients in the control group had 38.89%, 48.15 and 57.41% compliance at 1, 3 and 6 months after discharge. The incidence of adverse reactions after discharge was 9.26% in the observation group and 37.04% in the control group, and the comparison between the groups was statistically significant（P < 0.05）. Conclusions Continuing motivational interview can significantly improve the compliance of diabetic cataract patients after discharge from day surgery, and continuous interview after discharge can ensure the quality of nursing at home and reduce the incidence of adverse reactions, which has a high clinical application value. -
Key words:
- Diabetic cataract /
- Continuity of care /
- Follow-up compliance /
- Day surgery
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表 1 两组患者年龄、性别统计学分析结果（
$\bar x \pm s$ ）Table 1. Statistical analysis of age and gender of the two groups of patients（
$\bar x \pm s$ ）组别 样本量（n） 年龄（岁） 病程（a） 对照组 54 64.74 ± 5.44 9.46 ± 2.84 观察组 54 65.13 ± 5.50 9.26 ± 2.92 T − −0.371 −0.367 P − 0.711 0.714 
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表 2 两组患者出院后1个月复查意向对比[n（%）]
Table 2. Comparison of the reexamination intentions of the two groups of patients one month after discharge[n（%）]
分组 n 应该复查 知道复查且有条件复查
但未复查或未准时复查知道复查但
没有条件复查自我感觉没
有必要复查观察组 54 42（77.77） 6（11.11） 4（7.41） 2（3.70） 对照组 54 21（38.89） 8（14.81） 14（25.93） 11（20.37） χ2 19.072 P < 0.001
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表 3 两组患者复查依从性对比[n（%）]
Table 3. The compliance of patients in the two groups was compared[n（%）]
复查时间 依从性 观察组（n = 54） 对照组（n = 54） Z P 出院1个月 优 40（74.07） 21（38.90） 良 12（22.22） 23（42.60） −3.816 < 0.001 差 2（3.70） 10（18.50） 出院2个月 优 42（77.80） 24（44.40） 良 9（16.70） 23（42.60） −3.438 0.001* 差 3（5.60） 7（13.00） 出院3个月 优 44（81.48） 26（48.15） 良 9（16.67） 21（38.89） −3.708 < 0.001 差 1（1.85） 7（12.96） 出院4个月 优 44（81.5） 27（50.00） 良 8（14.80） 18（33.30） −3.501 < 0.001 差 2（3.70） 9（16.70） 出院5个月 优 45（83.30） 29（53.70） 良 7（13.00） 17（31.50） −3.334 0.001* 差 2（3.70） 8（14.80） 出院6个月 优 46（85.19） 31（57.41） 良 8（14.81） 18（33.33） −3.307 0.001* 差 0（0.00） 5（9.26） *P < 0.05。
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表 4 两组患者不良反应发生情况对比[n（%）]
Table 4. The occurrence of adverse reactions was compared between the two groups[n（%）]
分组 例数（n） 眼部感染 眼压升高 纤维渗出 角膜水肿 前房出血 不良反应总发生率 观察组 54 0（0.00） 1（1.85） 1（1.85） 3（5.56） 0（0.00） 5（9.26） 对照组 54 3（5.56） 4（7.41） 4（7.41） 6（11.11） 3（5.56） 20（37.04） χ2 1.371 0.839 0.839 0.485 1.371 11.711 P 0.242 0.360 0.360 0.486 0.242 0.001* *P < 0.05。
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