家庭医生责任制服务对高血压病管理效果评价

摘要

Objective:To investigate the value of family doctor responsibility system applied in hypertension management in Sha Tau kok community health service center.Method:A total of 294 hypertension patient in 223 households who were community voluntarily signed with “family doctor” for the family doctor service agreement were selected by purposive type cluster sampling method in July 2013.Self-designed questionnaire were adopted in accumulating patients basic information and the treatment compliance,rate of knowledge about health, community health services utilization rate,blood pressure,blood lipid,daily salt intake,body mass index, the average monthly cost of treatment and half a year heart cardiovascular disease incidence rate before and after the implementation of responsibility system of family doctor service.Result:The treatment compliance,rateof knowledge about health and the utilization rate of community health service agencies of hypertension patient were increased,the average daily salt intake,systolic pressure,diastolic pressure,plasma total cholesterol, triglyceride and low density lipoprotein cholesterol levels,body mass index,the average monthly cost of treatment and half of a year heart vascular disease incidence rate were lower than before implementing family doctor system service,while the plasma high-density lipoprotein cholesterol level were higher,the differences were statistically significant(P<0.05).Conclusion:Family doctor responsibility services applied in hypertension management can easily and efficiently improve hypertension patient treatment adherence and weight,blood pressure and blood lipid control,cultivate a healthy lifestyle of patients,reduce the cost of treatment and prevent the happening of the heart vascular disease incidence rate.Therefore,the family doctor responsibility services can meet the demand of community health service,the application effect is good,and it is worthy of clinical promotion.%目的：探讨沙头角社区卫生服务中心施行家庭医生责任制服务对于高血压病管理的实施效果。方法：采用立意式整群抽样方法选取2013年7月本社区自愿与“家庭医生”签订《家庭医生服务协议》的223户家庭中的高血压病患者294例，采用自制问卷调查患者的基本资料并收集实施家庭医生责任制服务前后高血压病患者的治疗依从性、健康知识知晓情况、对社区卫生服务机构的利用率、血压、血脂、每日食盐摄入量、体质量指数、平均每月治疗费用及半年内心脑血管疾病发生率等。结果：与实施家庭医生责任制服务前比较，实施后高血压病患者治疗依从性、健康知识知晓情况和对社区卫生服务机构的利用率均提高，平均每日食盐摄入量，收缩压、舒张压、血浆总胆固醇、甘油三酯和低密度脂蛋白水平、体质量指数、平均每月治疗费用及半年内心脑血管疾病发生率均降低，血浆高密度脂蛋白水平则升高，比较差异均有统计学意义（P<0.05）。结论：家庭医生责任制服务应用于高血压病管理可方便、高效地改善高血压病患者治疗依从性、体重、血压、血脂等的控制情况，有利于培养患者健康的生活方式，减少治疗费用并预防心脑血管疾病的发生，因此家庭医生责任制服务符合社区居民的医疗需求，其应用效果良好，值得临床推广使用。