乡村保健志愿者在泰国农村社区预防和减缓慢性肾病进展的综合护理模式。

IF 3 Q1 PRIMARY HEALTH CARE
Ampornpan Theeranut, Nonglak Methakanjanasak, Sunee Lertsinudom, Pattama Surit, Nichanun Panyaek, Saisamon Leeladapattarakul, Peangtikumporn Nilpetch, Pattapong Kessomboon, Chalongchai Chalermwat, Watcharapong Rintara, Wudipong Khongtong, Pawich Paktipat, Pannee Banchonhattakit, Darunee Chunlertrith, Amod Sharma, Ubon Cha'on, Sirirat Anutrakulchai
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引用次数: 0

摘要

简介慢性肾脏病(CKD)是泰国的一个主要健康问题,而健康行为是其风险和发展的核心。由于医疗保健人员短缺,村卫生志愿者(VHVs)一直与初级医疗保健系统合作。然而,尚未评估村卫生志愿者对减少慢性肾脏病的贡献。本研究旨在评估村卫生志愿者综合模式在预防和减缓慢性肾脏病及其风险因素方面的功效:这项基于人群的队列研究于 2017 年至 2019 年在泰国的一个农村社区进行。收集了参与者的基线临床和行为特征,包括 CKD、糖尿病、高血压和其他高危因素。综合护理模式由多学科护理团队发起,该团队针对慢性肾脏病的风险因素、健康知识普及和健康促进,促进、授权并培训了VHV。随后,对参与者进行了改变生活方式的教育和培训,并由自愿健康志愿者对其进行为期 18 个月的持续监测。结果显示,共有 831 名受试者参加了综合护理模式:共有 831 名受试者参与了研究,平均年龄为 57.5 岁,69.5% 为女性。其中,222 人(26.7%)被诊断为患有慢性肾脏病,绝大多数(95%)处于早期阶段(G1-G3 和 A1-A2)。采用护理模式后,高盐摄入、吸烟、饮酒、自行服用非甾体抗炎药(NSAID)等慢性肾脏病风险因素明显减少。此外,糖尿病患者的血红蛋白 A1c 明显降低,高血压患者的血压控制也比以前更好。最重要的是,慢性肾脏病组的估计肾小球滤过率的下降得到了改善,且低于非慢性肾脏病组:结论:通过 VHV 综合护理模式,普通人群和高危人群中与慢性肾脏病相关的危险因素明显减少,并有效延缓了慢性肾脏病的进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand.

Introduction: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors.

Methods: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared.

Results: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group.

Conclusion: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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