Abstract
BACKGROUND: Venous thrombosis (VTE) is a high-incidence disease that affects different systems of the body, but no comparative studies have been conducted to explore its incidence in different systems in patients with the coexistence of multiple diseases. Primary care is a medical institution that has the first contact with patients' conditions. The majority of outpatients suffer from multiple diseases, and they are more prone to VTE, which is of significance and requires investigation. At the same time, we observed that the primary care patients' cognition level of VTE is insufficiency at present, and the prevention and management of VTE in China is still in its infancy. Most studies focus on whether doctors and nurses are clear about the diagnosis and manifestations of VTE, however, few studies on patients' cognitive level and influencing factors of symptoms and prevention of VTE. Therefore, it is necessary to study the causes of cognitive deficiency of VTE from the perspective of patients, conduct targeted cognitive and behavioral interventions, and finally achieve the purpose of improving the effect of VTE prevention and management. AIM: This study aimed to explore the risk factors, cognitive level and cognitive potential influence factors of VTE in outpatients of primary care in Shanghai, as well as which diseases, are more likely to promote occurrence of VTE among patients with multiple diseases. METHODS: A total of 710 patients were included in the analysis. Shanghai in China is divided into urban and suburban areas by their geographical location, and a random sample of 10 primary care areas was investigated, including 5 urban areas and 5 suburban areas. The Padua scale and the VTE cognitive level-related knowledge test scale were used for the investigation. Statistical software was used to conduct univariate Pearson correlation analysis and multivariate logistic regression analysis for VTE high-risk factors among outpatients of primary care. Furthermore, the high-risk factors for VTE and the types of chronic disease in patients with multiple diseases were subjected to subgroup analyses. t-test was used to statistically analyze cognitive level of VTE and the potential influence factors related to the patients' VTE cognitive level. RESULTS: Univariate analysis of risk factors for VTE in 710 outpatients showed that age (χ (2)=83.895, P<0.001), education (χ (2)=8.324, P=0.004), region (χ (2)=63.936, P<0.001), chronic disease (χ (2)=18.198, P<0.001) and the coexistence of multiple diseases (χ (2)=61.347, P<0.001) were the main risk factors for VTE risk in patients. Logistic multivariate regression analysis showed that age, region, chronic diseases and the coexistence of multiple diseases were independent risk factors for VTE risk in patients. The correlation between high risk of VTE in patients with multiple diseases and various types of chronic diseases was further analyzed by logistic multivariate regression. The results showed that diabetes mellitus (OR=1.636 [95% CI, 1.030-2.599], P=0.037), cerebral infarction (OR=8.484 [95% CI, 4.615-15.597], P<0.001), coronary heart disease (OR=2.987 [95% CI, 1.699-5.252], P<0.001), intracerebral hemorrhage (OR=15.130 [95% CI, 4.707-48.630], P<0.001), respiratory diseases (OR=3.470, [95% CI, 1.428-8.43], P=0.006) and malignant tumors (OR=4.576, [95% CI, 1.85-11.315], P=0.001) were independent risk factors for VTE among patients with co-existing diseases, and the risks from high to low were cerebral hemorrhage>cerebral infarction>malignant tumor>respiratory system disease>coronary heart disease> diabetes. In addition, patients' age (t=6.869, P<0.001), region (t=3.420, P<0.001), education level (t=-7.341, P<0.001), chronic disease (t=5.875, P<0.001), BMI (t=6.404, P=0.012), smoking (t=4.152, P=0.042) were related to the VTE cognitive level. CONCLUSION: General practitioners should pay close attention to independent risk factors for VTE among patients in routine outpatient care, especially patients with co-existing diseases with independent risk for VTE, placing them high risk of VTE. At the same time, health education and other measures should be strengthened to improve the patients' awareness and cognitive level of VTE to prevent the occurrence of VTE and its related complications.