高血压患者强化管理与常规管理的比较研究
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摘要
目的:探讨高血压患者强化管理(MUST模式)与常规管理的比较研究。方法:建立高血压患者MUST管理模式,并与传统的常规管理模式比较,分析提高患者药物治疗、生活方式、血压监测、防治知识四个方面的依从性。210例高血压患者按照随机数字法分为两组,进入MUST强化管理模式的为干预组(n=105),采用常规管理模式的为对照组(n=105),均进行为期12个月的监测。分析比较两组血压控制和依从性的改进情况。结果:对药物治疗、生活方式、血压监测、防治知识四个分项依从性的分析,干预组上述四项指标依从性均得到显著改善,并且均分别优于对照组。干预组与对照组比较,收缩压和舒张压下降更多;干预组体质指数、胆固醇、甘油三酯、低密度脂蛋白胆固醇监测后与对照组同期比较均降低,差异均有统计学意义(P均<0.05)。监测后干预组患者第12个月时完全从医比例为75.8%;干预组与对照组的血压控制率比较,始终较高,差异有统计学意义(χ2=15.87~20.15,P<0.05)。干预组在第3、6、9、12个月四个监测点的从医比例均分别高于对照组;而完全不从医比例每个监测点均显著低于对照组,差异均有统计学意义(χ2=12.32~18.45,P<0.05)结论:MUST模式强调家属作为监督者的身份参与高血压教育的重要性,可显著提高患者血压控制率和依从性。
Objective: To compare the differences between strengthening management(MUST) and conventional management in patients with hypertension. Methods: A total of 210 hypertension patients were randomly divided into 2 groups, Intervention group, the patients received strengthening management, in which the family member was involved for the education, and Control group, the patients received conventional management. n=105 in each group. The 4 compliances as medication, life style, blood pressure monitoring and prevention knowledge were compared between 2 groups and followed-up for 1 year. Results: The above 4 compliances in Intervention group were respectively and obviously improved than those in Control group. Compared with Control group, the Intervention group presented decreased systolic and diastolic blood pressure, decreased BMI, TC, TG and LDL-C, all P<0.05. At the end of 12 months follow-up period, Intervention group had 75.8% of patients kept clinical consulting, and it also had better control rate of blood pressure(χ2=15.87-20.15, P<0.05) than those in Control group. Intervention group also had higher clinical consulting rate at 3, 6, 9 and 12 months of examination time respectively(χ2=12.32-18.45, P<0.05). Conclusion: MUST model emphasizes the family member involved patient education, which may significantly improve the control rate of blood pressure and the related compliances in patients with hypertension.
Objective: To compare the differences between strengthening management(MUST) and conventional management in patients with hypertension. Methods: A total of 210 hypertension patients were randomly divided into 2 groups, Intervention group, the patients received strengthening management, in which the family member was involved for the education, and Control group, the patients received conventional management. n=105 in each group. The 4 compliances as medication, life style, blood pressure monitoring and prevention knowledge were compared between 2 groups and followed-up for 1 year. Results: The above 4 compliances in Intervention group were respectively and obviously improved than those in Control group. Compared with Control group, the Intervention group presented decreased systolic and diastolic blood pressure, decreased BMI, TC, TG and LDL-C, all P<0.05. At the end of 12 months follow-up period, Intervention group had 75.8% of patients kept clinical consulting, and it also had better control rate of blood pressure(χ2=15.87-20.15, P<0.05) than those in Control group. Intervention group also had higher clinical consulting rate at 3, 6, 9 and 12 months of examination time respectively(χ2=12.32-18.45, P<0.05). Conclusion: MUST model emphasizes the family member involved patient education, which may significantly improve the control rate of blood pressure and the related compliances in patients with hypertension.
引文
[1]陆再英,终南山.内科学.第7版.北京:人民卫生出版社,2008:274-275.
[2]Prado JC Jr,Mion D Jr.Adherence to medication:the importance of research in primary care.American Journal of Hypertension,2010,23:109-109.
[3]于文,韩静,孙迎俊,等.建立家属参与的糖尿病患者管理教育新模式.中华糖尿病杂志,2012,4:85-89.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010.中华高血压杂志,2011,19:701-743.
[5]李立明,饶克勤,孔灵芝.中国居民2002年营养与健康状况调查.中华流行病学杂志,2005,26:478-484.
[6]Corrao G,Parodi A,Nicotra F,et al.Better compliance to antihypertensive medications reduces cardiovascular risk.J Hypertens,2011,29:610-618.
[7]Pittman DG,Tao Z,Chen W,et a1.Antihypertensive medication adherence and subsequent healthcare utilization and costs,Am J Manag Care,2010,16:568-576.
[8]Criswell TJ,Weber,Carter BL,et al.Effect of self-efficacy and social support on adherence to antihypertensive drugs.Pharmacotherapy,2010,30:432-441.
[9]Ferrara AL,Pacioni D,Di Fronzo V,et al.Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients:a 2-year follow-up study.J Clin Hypertens,2012,14:767-772.
[10]Chowdhury EK,Owen A,Krum H,et al.Barriers to achieving blood pressure treatment targets in elderly hypertensive individuals.J Hum Hypertens,2013,10:1038.
[11]Inqram RR,Ivanov LL.Examining the association of health literacy and health behaviors in African American older adults:does health literacy affect adherence to antihypertensive regimens?J Gerontol Nurs.2013,39:22-32.
[12]Sacks FM,Svetkey LP,Vollmer WM,et a1.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension(DASH)diet.DASH-Sodium Collaborative Research Group.Engl J Med,2001,344:3-10.
[13]杨天伦,杨达峰.24小时动态血压的地位进一步提升-2011年英国高血压指南的解读.中国循环杂志,2012,27:27-29.
[14]Puigventós F,LlodràV,Vilanova M,et al.Cumplimiento terapéutico en eltratamiento dela hipertensión:10 anos de pulicaciones en Espa na.Med Clin(Barc),1997,109:702-706.
[15]Ho PM,Bryson CL,Rumsfeld JS.Medication adherence.Its importance in cardiovascular outcomes.Circulation.2009,119:3028-3035.
[16]Takiya LN,Peterson AM,Finley RS.Meta-analysis of interventions for medication adherence to antihypertensives.Ann Pharmacother,2004.38:1617-1624.
[17]孙宁玲,姚丹.顽固性高血压的评估及治疗进展.中国循环杂志,2012,27:251-253.
[2]Prado JC Jr,Mion D Jr.Adherence to medication:the importance of research in primary care.American Journal of Hypertension,2010,23:109-109.
[3]于文,韩静,孙迎俊,等.建立家属参与的糖尿病患者管理教育新模式.中华糖尿病杂志,2012,4:85-89.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010.中华高血压杂志,2011,19:701-743.
[5]李立明,饶克勤,孔灵芝.中国居民2002年营养与健康状况调查.中华流行病学杂志,2005,26:478-484.
[6]Corrao G,Parodi A,Nicotra F,et al.Better compliance to antihypertensive medications reduces cardiovascular risk.J Hypertens,2011,29:610-618.
[7]Pittman DG,Tao Z,Chen W,et a1.Antihypertensive medication adherence and subsequent healthcare utilization and costs,Am J Manag Care,2010,16:568-576.
[8]Criswell TJ,Weber,Carter BL,et al.Effect of self-efficacy and social support on adherence to antihypertensive drugs.Pharmacotherapy,2010,30:432-441.
[9]Ferrara AL,Pacioni D,Di Fronzo V,et al.Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients:a 2-year follow-up study.J Clin Hypertens,2012,14:767-772.
[10]Chowdhury EK,Owen A,Krum H,et al.Barriers to achieving blood pressure treatment targets in elderly hypertensive individuals.J Hum Hypertens,2013,10:1038.
[11]Inqram RR,Ivanov LL.Examining the association of health literacy and health behaviors in African American older adults:does health literacy affect adherence to antihypertensive regimens?J Gerontol Nurs.2013,39:22-32.
[12]Sacks FM,Svetkey LP,Vollmer WM,et a1.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension(DASH)diet.DASH-Sodium Collaborative Research Group.Engl J Med,2001,344:3-10.
[13]杨天伦,杨达峰.24小时动态血压的地位进一步提升-2011年英国高血压指南的解读.中国循环杂志,2012,27:27-29.
[14]Puigventós F,LlodràV,Vilanova M,et al.Cumplimiento terapéutico en eltratamiento dela hipertensión:10 anos de pulicaciones en Espa na.Med Clin(Barc),1997,109:702-706.
[15]Ho PM,Bryson CL,Rumsfeld JS.Medication adherence.Its importance in cardiovascular outcomes.Circulation.2009,119:3028-3035.
[16]Takiya LN,Peterson AM,Finley RS.Meta-analysis of interventions for medication adherence to antihypertensives.Ann Pharmacother,2004.38:1617-1624.
[17]孙宁玲,姚丹.顽固性高血压的评估及治疗进展.中国循环杂志,2012,27:251-253.