Enhancing the education management on Asthma changing the model of medical service Peking University Renmin Hospital He Quanying

So many problems existed in medical service, why? What the solutions? Difficulties: unfair locations of the medical resources countryside urban High cost：different forms for medical cost new drugs’ development slowly increased of people’s income Health reform the hospital development service for profit

Unhealthy doctor-patient relationship becomes more and more tension: trustless restricting the very development of physicians Why? The way paid for medical service changed constitution of the hospitals , professionalism education, medical reform, Excessive Medical Care , Negative function of the multimedia

mission for medicine Profit---for public hospitals, physicians lost themselves Seeking to make a profit Work passively Promoting the health of all. in this complicated context, what physicians should do? how?

the administration of Asthma began in 1993 in China, after many years’ practice and exploration, the following model formed. 三 位 一 体 医 疗 服 务 模 式 哮喘宣教中心 哮喘专病门诊 哮喘患者协会

special service for Asthma is the primary point for education management on Asthma. Physician there will be responsible for the diagnosis, making plan on treatment and so on. public education center on Asthma is the further step, it makes more convenience for doctor-patient communications. The association of asthma patients is the platform we carry out our education, it provides a ideal atmosphere between doctor and patient. Doctor-patient relationship is the fatal factor here.

The association of asthma patients founded in May,2001. More than 700 members now.

An activity will be hold at weekend every four months (free) An activity will be hold at weekend every four months (free). Members will be informed and take part in as they want. Always 100-150 members.

Content: Lectures on Asthma control; Communication between asthma patients, etc. It will be changed depend on the members’ willing, but always concentrate on the Asthma control & Asthma control in China.

“Public education center on Asthma ” founded in Nov,2001. A specialist gives advise, also some training to his patients

give patients free materials develop volunteers make up files ,etc.

“special service for Asthma” began in April,2003 “special service for Asthma” began in April,2003.A specialist will provide his services.

patients get their diagnosis and relative treatment plan; know more on Asthma; also have more confidence.

relative activities of doctors on Asthma

Long term treatment for Asthma control and management Working for goals evaluating Monitor and maintain the control

in 2005 表1 the basic knowledge known by patients 分 组 调 查 人 数 哮喘是一种 慢 性 疾 病 哮喘变应性 炎 症 本 质 激素是控制气道 炎症最有效药物 吸入疗法 用药的优点 吸入型药物 正 确 用 法 峰速仪为监测 病情重要工具 哮 喘 控 制 目 标 预 防 诱 因重 要 性 人数 构成 比 （％） 教 育 73 100.0 61 83.6 66 90.4 72 98.6 68 93.2 71 97.3 67 91.8 对 照 30 20 66.7 6 20.0 13 43.3 19 63.3 26 86.7 18 60.0 23 76.7 x2值 23．28 37．78 26．37 26．25 4．25 56．24 22．26 4．40 P值 <0.01 <0.05

表2 the corporation between doctor and patient 分 组 调 查 人 数 信 任 经 治 医 生 选 择 固 定 医 师 完全服从治疗方案 能 够 定 期 随 访 构成 比 （％） 教 育 73 69 94.5 60 82.2 48 65.8 对 照 30 26 86.7 4 13.3 10 33.3 12 40.0 x2值 0.90 39.9 9.08 5.79 P值 >0.05 <0.01 <0.05

表3 activities taken by patients 分 组 调 查 人 数 曾经坚持 3个月以上 吸入激素 仍然坚持 吸入方 法正确 拥有 峰速仪 经常监测 峰流速 个人记录峰 流速值 峰流速记录 供医生参考 注意预防 哮喘诱因 人数 构成 比 （％） 教 育 73 69 94.5 60 82.2 72 98.6 57 78.1 35 47.9 31 42.5 25 34.2 67 91.8 对 照 30 11 36.7 17 26 86.7 8 26.7 1 3.3 23 76.7 x2值 37.76 20.58 4．25 24.14 18．61 15．20 10．77 4.40 P值 <0.01 <0.05

表4 the control of Asthma 分组 调 查 人 数 白天症状 (≤2天/周) 无因哮喘 夜间扰醒 日常活动 不受限 按需用β2 激动剂 (≤2天/周, 且≤4次/周) 病情无 急性加重 无急诊 或住院 无治疗相关 不良反应 而改变治疗 良好控制 构成 比 （％） 构 成 教育组 56 50 89.3 49 87.5 52 92.9 45 80.4 39 69.6 100.0 34 60.7 对 照 组 30 22 73.3 12 40.0 18 60.0 14 46.7 8 26.7 3 10.0 x2值 3．65 21．38 13．93 10．30 14．56 13．46 － 20．50 P值 >0.05 <0.01

表5 life quality evaluation for patients of Asthma 分 组 调查 人数 活动 受限 （60） 哮喘 症状 （40） 心理 状况 （30）＊ 对刺激 原反应 （25） 对自身健 康的关心 （20） 哮喘生命 质量总分 （175） 教 育 56 50±6 37±3 27±3 24±2 17±3 155±12 对 照 30 44±10 31±6 23±5 21±4 13±4 132±24 t值 3．33 5．33 4．94 3．26 4．92 5．17 P值 <0.01

表6 hospital medical resources using by patients 分 组 调 查 人 数 非 预 约 门 诊 就 医 急 诊 就 医 住 院 人数 构成比（％） 人均次数 教 育 56 9 16.1 0.5±1.7 4 7.1 0.2±0.6 2 3.6 0.1±0.3 对 照 30 20 66.7 2.1±2.8 12 40.0 0.6±0.9 13.3 0.2±0.7 t值 4.82 3.55 1.69 x2值 22．38 13．93 1．56 P值 <0.01 >0.05

In 2006 表7 patients’ knowledge & information level on Asthma 分 组 例 数 认为哮喘本质 是气道慢性炎症性疾病 例（％） 认为持续期每日均应规律使用的一线药物是吸入型糖皮质激素 认为哮喘可以被长期控制 教 育 100 95(95%) 对 照 427 272(64%) 182(43%) 316(74%) x2值 37.543 89.146 20.805 P值 <0.01

表8 activities taken by patients for Asthma control 分组 例 数 曾接受过 肺功能测定 例（％） 拥有医生 制定的 长期治疗计划 每日坚持 规律吸入 糖皮质激素 拥有呼气 峰流速仪 每日监测 呼气峰流速 曾吸烟人数例（％）12(12%)94(22%)5.255<0.05 已戒烟人数 教育组 100 93(93%) 91(91%) 82(82%) 42(42%) 11(11%) 12(12%) 7(58%) 对照组 427 339(79%) 166(39%) 232(54%) 80(19%) 21(5%) 94(22%) 29(31%) χ2值 3．33 10.155 88.109 25.755 24.650 5.255 5.057 P值 <0.01 <0.05

表9 the condition control 分组 例数 哮喘控制测试（ACT）评分≥20分例（％） 过去一年中因哮喘加重住院 例（％） 过去一年中因哮喘加重看急诊 在职患者例（％） 过去一年中因哮喘误工例（％） 教育组 100 85(85%) 4(4%) 18(18%) 49(49％) 10(20％) 对照组 427 159(37%) 99(23%) 136(32%) 137(32％) 76(55％) χ2值 3．33 74.345 19.431 7.515 4.678 P值 <0.01 <0.05

published in 2005, the Asthma, never say goodbye---from the Asthma patients

on Oct.11st, 2007 the Ministry of Public Health Certificated our tries on Asthma education

after years’ exploration, it is the Asthma itself that is the very enemy of mine, the concentration should not be the doctor-patient resistance.

unregulated Asthma treatment cost more, even sometimes soaring.

our exploration will reduce our cost significantly and very meaningful for our whole society.

Asthma control is significant for our country

patients should behavior more actively, then the medical itself would be really meaningful!

We need new doctor-patient relationship

Changing the model of medical service to provide better services.

Problems on Asthma treatment existed in the past years in China

Problems for the old model of medical service

Meanings for our exploration: Reduce the cost Enhance the life quality of patients It’s a meaningful example for other kinds of chronic diseases THANK YOU