Page 97 - 2022-25-中国全科医学

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and behaviors in osteoarthritis patients，it is difficult to diagnose，treat and manage osteoarthritis. Objective To understand
healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients，providing evidence for improving
the diagnosis and treatment of such patients in the community. Methods This was a mixed-methods study. From May to June
2019，interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors，as well
as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners（GPs） from
a general hospital in a regional healthcare consortium in Shanghai's Yangpu District，and a convenience sample of 12 GPs and
12 osteoarthritis patients from six community health centers（CHCs） in the same consortium. Then from June 2019 to December
2020，425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend
a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews（excluding
some highly subjective and less quantifiable indicators） for understanding their socio-demographic information，disease status，
healthcare-seeking perceptions and behaviors，self-management and utilization of the APP for chronic disease management.
Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis.
Results The following themes were extracted from the interviews：patients' insufficient awareness of osteoarthritis，lack of
management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven
of the 425 cases（93.4%） who effectively completed the questionnaire were included for quantitative analysis. One hundred
and fifty-two（38.3%）respondents understood osteoarthritis，and 79（52.0%）of them acquired relevant knowledge from the
media，and other 50（32.9%）from ward-mates. Two hundred（50.4%）respondents knew the treatments for osteoarthritis，
including 91（45.5%） knowing exercise and physical therapies，and 105（52.5%） knowing treatment with painkillers. The
healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex，BMI，pain level，impact of pain on sleep
quality，and previous healthcare-seeking experience（P<0.05）. The results of regression analysis demonstrated that sex，
BMI，pain level，previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking
behavior（P<0.05）. Conclusion Community-living patients with osteoarthritis had insufficient awareness of healthcare-
seeking and weak self-management awareness，and their healthcare-seeking behaviors were affected by multiple factors. To
improve these patients' healthcare-seeking perceptions and behaviors，priority should be given to take actions to enhance patients'
healthcare-seeking perceptions，train patients' self-management ability，better GPs' diagnostic and therapeutic skills，improve
doctors and patients' negative attitude toward osteoarthritis treatment，and promote patients seeking healthcare actively.
【Key words】 Osteoarthritis；Community health services；Clinic visits；Root cause analysis；Mixed-methods study

骨关节炎是临床常见病及多发病，为一种以关节及 1 对象与方法
软骨发生退行性病变和关节周边骨质增生为主要特征的 混合研究设计：通过定性访谈从医患双方了解患者
慢性关节疾病。年龄为骨关节炎患病的独立危险因素， 对于疾病的就医认知、行为特点和可能的影响因素（包
并且随着年龄的增长，骨关节炎患病率升高 ［1］ 。骨关 括疾病管理的现况、障碍和建议）；结合访谈归纳的主
节炎总患病率约为 15%，≥ 40 岁中老年人群的患病率 题，除去部分具有较大主观性难以采用问卷量化的指标，
为 10%~17%，≥ 60 岁老年人的患病率为 50%，≥ 75 设计定量问卷，进一步对患者就医认知和行为特点的量
岁老年人的患病率达到 80% ［2］ 。贺丹 ［3］ 研究发现，随 化情况做出分析。
着我国人口老龄化水平的上升，骨关节炎患者家庭及社 1.1 定性研究
会经济负担进一步加重。一项对近 27 年 195 个国家的 1.1.1 访谈对象 2019 年 5—6 月，采用目的抽样法从
研究发现：各国骨关节炎患病率、发病率和残障生存年 上海市杨浦区一家区域医疗中心的综合医院选取骨科医
限（YLDs）有差异，但随着预期寿命的增加和全球人 生和全科医生各 5 例，同时在区域内 12 家社区卫生服
口的老龄化，以上指标均呈上升趋势，给世界公共卫生 务中心中选取 6 家，从每家选中的社区卫生服务中心方
带来严峻的挑战 ［4］ 。唐超 ［5］ 研究发现，近 2/3 的患者 便抽取 2 例全科医生、2 例前来就诊的骨关节炎患者，
对骨关节炎的疾病临床表现了解不清。我国中老年人群 进行多方访谈。受访医师纳入标准：（1）有≥ 2 年门
普遍缺乏骨关节炎基础知识、危险因素、诊治及预防等 诊经历；（2）有兴趣参与并认同本研究。受访患者纳
相关疾病认知 ［6-7］ 。本研究选取综合医院骨科和全科医 入标准：（1）经骨科医师确诊为骨关节炎；（2）年龄
生及社区全科医生和患者进行混合方法学研究，了解患 ≥ 18 周岁，具有一定的阅读或理解力；（3）同意参加
者对骨关节炎的认知和行为现状，分析影响患者就医和 本次调查。受访患者排除标准：（1）伴有妊娠、严重
疾病管理的问题及障碍，为改善骨关节炎患者的就医行 躯体疾病或精神疾病者；（2）患各类风湿、类风湿及
为及疾病预后提供优化策略。 化脓性关节炎等其他类型的骨关节疾病。