社区控制技术对浙江省社区高血压人群干预效果的评价分析

摘要

目的：评价以“规模化、规范化、信息化”为核心的高血压社区控制技术对高血压人群的管理效果。方法2010年以《中国高血压防治指南》为依据，建立以“规模化、规范化、信息化”为核心的高血压社区控制技术，选择浙江省有代表性的城市、城镇、农村社区高血压人群为研究对象进行大规模社区干预试验。按照高血压社区控制技术制订实施方案，规范化培训干预组医生，按照方案要求对干预组高血压患者进行分级管理。结果截至2013年12月共管理了高血压患者20807例。其中干预组从基线的8996例增加到12295例，规范管理率达到86.8%；干预组高血压患者平均收缩压和平均舒张压分别下降了11.21 mmHg和8.55 mmHg (均为P﹤0.05)，治疗率和控制率由基线时的55.4%和38.6%提高到86.7%和77.8%(均为P﹤0.05)，心血管危险因素有显著改善(均为P﹤0.05)，急性心血管事件发生呈下降趋势。结论高血压社区控制技术能有效提高社区高血压规范管理率，有效改善社区高血压人群防治效果。%Objective To evaluate the effects of hypertension community control technique, which centered on ‘scalization, standardization, informatization ' , on community hypertension management in Zhejiang Province. Methods We established the hypertension community control technique based on 2005 Chinese guidelines for the management of hypertension, and conducted a large-scale community-based intervention trial. The selected communities were representative communities from city, town and countryside in Zhejiang province. An implement scheme was developed according to the hypertension community control technique. Grass-roots doctors in intervention group were trained standardly and required to manage hypertentives based on the implement scheme. Hypertension community standardized management rate, hypertensives' blood pressure, cardiovascular risk factors, awareness rate, treatment rate, control rate, and incidence of acute cardiovascular events were investigated. Results Till December 2013, 20 807 hypertensives were enrolled in the management, and the number was increased from 8 996 to 12 295 in intervention group. Among hypertensives in intervention group, the standardized management rate was 86. 8%, as well as the average systolic blood pressure ( SBP) and diastolic blood pressure ( DBP) declined 11. 21 mmHg and 8. 55 mmHg, respectively ( both P﹤0. 05). The treatment rate improved from 55. 4% to 86. 7% (P﹤0. 05), and the management rate from 38. 6% to 77. 8% in the intervention group. Also, the intervention was effective in significantly ameliorated cardiovascular risk factors while the incidence rate of acute cardiovascular events had decreased. Conclusions Hypertension community control technique can improve standardized management rate, and effectively prevent and control hypertension at community level.