摘要
目的探讨个案管理模式在老年高血压管理中的应用。方法入选2007年1月至10月在西安交通大学第一医院门诊及病房治疗的老年原发性高血压患者106例，随机分为常规治疗组与个案管理组。常规治疗组按医院现有诊疗常规，被动接受随访及就诊；个案管理组接受以心血管专科医生为核心的个案管理团队的综合治疗、主动随访，并建立病案资料。治疗管理2年后观察2组患者降压达标率，抑郁、焦虑状态改善及生存质量改善情况。结果2组患者经过治疗后降压达标率均明显提高（常规治疗组由32．8％提高到67．5％；个案管理组由33．7％提高到83．4％）；焦虑自评量表（SAS）、抑郁自评量表（SDS）评分均减少（常规治疗组分别由574-10、56±11减至40±9、48-4-10；个案管理组由56±10、57±10减至35±9、40±9）；生存质量明显改善（常规治疗组生存质量评分由65±13提升至85±14；个案管理组则由64±13提升至98±14），上述指标2组自身前后比较差异均有统计学意义，2组间治疗后比较差异有统计学意义，均P〈0．05。2组治疗前后降压达标率、SAS、SDS及生存质量评分的差值相互比较，差异有统计学意义，P值分别为0．007、0．032、0．008、0．017。结论个案管理模式对老年高血压患者的降压达标率、SAS、SDS及生存质量评分等指标的改善更为显著。它能够从全科医学的角度对老年高血压患者实行整体、深入及动态化的管理，是一种较好的慢性病管理模式。
Objective To explore application of case management for hypertension in the elderly. Methods In total, 106 elderly patients with hypertension treated at outpatient and inpatient departments of the First Affiliated Hospital of Xian Jiaotong University were recruited during January to October 2007, and divided randomly into two groups, one with conventional management and the other with case management. Patients with conventional treatment accepted routine diagnostic and therapeutic procedures and were followed-up passively, and patients with case management accepted integrated therapy and active interview provided by a team with a cardiovascular specialist as core, were followed-up actively and their medical records were kept in files. Percentage of the patients with blood pressure lowered to meet criteria of effectiveness and their improvement in depression and anxiety status and quality of life were evaluated two years after management for the two groups. Results Percentage of patients with their blood pressure lowered to meet effective criteria increased significantly in both of the groups, from 32. 8% to 67.5% in patients with conventional management and from 33.7% to 83.4% in those with case management （ P = 0. 007 ） , respectively. Scores of self-rating anxiety scale （SAS） and self-rating depression scale （SDS） decreased in patients of the both groups, from 57±10 and 56 - 11 before management to 40±9 and 48±10 after it, respectively in patients of conventional management （ P = 0. 032 ） , and from 56±10 and 57±10 before management to 35±9 and 40± 9 after it （ P = 0. 008 ）, respectively in those with case management ; and scores of quality of life improved in patients of the two group, from 65 ± 13 before management to 85 ± 14 after it in those with conventional management, and from 64 ± 13 before management to 98 ± 14 after it in those with case management （ P = 0. 017） , respectively. Conclusions Case management is better for chronic diseases and recommended in management for the elderly with hypertension, which can improve their targets of blood pressure lowering, decrease their scores of SAS and SDS and improve their quality of life, with an integrated, in-depth, continuous management.
出处
《中华全科医师杂志》
2010年第11期749-752,共4页
Chinese Journal of General Practitioners
关键词
高血压
疾病管理
评价研究
老年人
Hypertension
Disease management
Evaluation
Elderly
