摘要
目的 评价社区-医院分级管理对高血压患者血压管理和控制的效果,分析其影响因素,探讨适合社区医院的高血压慢病管理模式.方法 采用整群抽样方法,于2008年12月至2009年12月对北京市朝阳区双井、劲松、小红门3个社区卫生服务中心的258例高血压居民进行分级管理,登记健康档案,随访患者的血压控制情况,并对可能的影响因素进行分析.结果 通过1年的分级管理,患者的血压控制率为85.3%.体重指数、高血压相关知识知晓情况、吸烟、缺乏运动、服药依从性对血压控制率的影响显著.其中以45～64岁年龄段患者、文化程度较高的患者、体重指数正常者、高血压相关知识知晓率高者、生活方式健康者、规律服药者血压控制率更高.结论 社区-医院分级管理可有效提高高血压患者血压控制率,影响分级管理效果的影响因素有体重指数、高血压相关知识知晓率、生活方式和服药依从性.
Objective To evaluate the effect of the management and control of blood pressure in hypertensive patients with community-hospital classification management and analyze the influencing factors. To explore suitable chronic disease （hypertension）management model in community hospital. Method 258 residents with hypertension from Shuangjing, Jinsong and Xiaohongmen community hospitals were involved in the classification management, cluster sampling method was used. The patients were registrated and follow-up by community hospital＇ s doctors, hyperten- sion control rate and the influence factors were studied and analyzed. Result After one year＇ s management, the con- trol rate of hypertention was 85.3%. The BMI, knowledge of hypertention,smoking status, regular exercise, medi- cation compliance were significantly related to the control rate of hypertension. The control rate of the patients aged from 45 to 64 years old, well educated, with normal BMI,with rich knowledges of hypertension, no smoking,regular exercise and with good medication compliance were better than the that of the other group. Conclusion Community-Hospital classification management can effectively improve the control rate of hypertension. The influence factors in- clude BMI, knowledge of hypertension, smoking and regular excercise and medication compliance.
出处
《中国医刊》
CAS
2014年第3期24-27,共4页
Chinese Journal of Medicine
基金
首发基金(2007-1048)
关键词
高血压
社区-医院分级管理
影响因素
慢病管理
Hypertension
Community-Hospital classification management
Influence factors
Chronic disease admin-istration
