山东昌乐县社区高血压规范化管理效果初析

摘要

Objective To describe the effects of community_based standardized management on the control of hypertension.Methods In community ,hypertension patients above 18 were screened out by the trained physicians through health examination.Then patients were managed and given both drug therapy and non_drug treatment. The results were checked by self pre_control and post_control study.The different rates before study and after study showed the result of qualitative data ,and the mean of the differences of before study and after study showed the result of quantitative data. Results By the end of 2009 , a total of 3930 hypertension patients (47.61% for male ,mean age:58.87 ± 10.81 years ) with full information had been under management for one year.After standard-ized management ,the results of systolic blood pressure ,diastolic blood pressure ,smoking rate ,drinking rate ,no sporting rate ,salt intaking rate were down to 12.07mmHg (95% CI:-12.53~ -11.60) ,5.89mmHg(95% CI:-6.18~ -5.59) ,4.87% (95% CI:-5.72% ~ -4.03% ) ,5.13% (95% CI:-6.00% ~ -4.26% ) ,8.39% (95% CI:-9.72% ~ -7.05% ) ,9.43% (95% CI:-10.79% ~ -8.07% )respectively.For all patients ,the control rate of hypertension rose to 34.86% ,with the management effect of 29.49% (95% CI:28.07% ~30.92% ). The longer the management ,the larger the difference of control rates were found between different sexes.Conclusions Community standardized management may significantly improve the control rate of hypertension.%目的通过在昌乐县社区开展高血压规范化管理，描述其对血压控制的效果。方法由经过规范化培训的社区医生通过健康体检筛查等方法发现高血压患者，对符合条件的患者纳入管理，进行药物和非药物治疗；采用自身对照的方法查看高血压控制率的干预效果。高血压控制率干预效果：定性资料干预效果为干预前后控制率之差，定量资料干预效果为干预前后数据差值的均值。结果到2009年12月底，规范化管理满1年的高血压患者且资料齐全的共计3930名，男性47.61％，平均年龄（58.87±10.81）岁。规范化管理后，收缩压下降12.07mmHg （95％ CI：-12.53～-11.60），舒张压下降5.89mmHg （95％ CI：-6.18～-5.59），吸烟率下降4.87％（95％ CI：-5.72％～-4.03％），饮酒率下降5.13％（95％ CI：-6.00％～-4.26％），不运动率下降8.39％（95％ CI：-9.72％～-7.05％），口味偏咸率下降9.43％（95％ CI：-10.79％～-8.07％）。基线时血压控制率为8.42％，1年后高血压的控制率达到34.86％，管理效果为27.46％（95％ CI：26.07％～29.92％），各个不同特征项目组的患者血压控制率均有显著升高，且男女性血压控制率均随着规范化管理时间的延长而升高。结论在社区开展高血压规范化管理可以显著的提高高血压的控制率。