社区综合防治合作模式对基层高血压患者控制率的影响
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摘要
目的观察社区综合防治健康管理模式对基层高血压患者控制率的影响。方法收集2012年7月至2013年7月广州参与研究的三级医院及6家社区卫生服务中心收治的初诊原发性高血压(高血压)患者2 383例,患者入组后随机分为综合管理组和常规治疗组。常规治疗组:按照高血压常规给予降压药治疗及根据血压情况作出调整。综合管理组:三级医院与社区卫生服务团队合作,运用综合防治健康管理模式治疗高血压患者,针对高血压危险因素进行筛查,在严格控制血压的同时,尽可能地干预危险因素,并进行定期随访(随访时间为12个月)。观察两组患者的血压控制水平、危险因素控制及高血压并发症发生情况等。结果随访12个月后,与常规治疗组相比,综合管理组依从性显著高于常规治疗组,不良反应少,差异有统计学意义(P<0.001)。综合管理组血压控制的显效率及总有效率显著高于常规管理组,而且收缩压、舒张压进一步改善,差异有统计学意义(P<0.001)。综合管理组吸烟、饮酒患者比例显著下降、基本身体指标(体质量指数、腰围)显著降低、血脂代谢紊乱情况改善、规律服用降压药物并定期监测血压患者比例显著增加,差异有统计学意义(P<0.001)。综合管理组随访期间发生包括脑卒中、心力衰竭、冠状动脉粥样硬化性心脏(冠心病)等并发症事件总发生率显著低于常规治疗组,差异有统计学意义(4.7%vs. 9.4%,P<0.001)。结论应用社区综合防治模式对基层高血压患者进行管理和干预,效果满意,值得临床推广应用。
ObjectivesTo investigate the influence of comprehensive prevention and control measures on the control of hypertension of patients from grass-roots community.MethodsTotally 2 383 cases of newly diagnosed hypertension patients were collected from July 2012 to July 2013 in the tertiary and 6 community hospitals in Guangzhou,which were randomly divided into general therapy group and comprehensive management group. In general therapy group,the patients were treated by general administration of antihypertensive drugs,which was modulated according to blood pressure. In comprehensive management group:the groups from the tertiary and community hospitals collaborated and the patients were treated by the integrated health management model. The risk factors of hypertension were screened and were interfered as much as possible when the blood pressure was strictly controlled and followed up regularly(follow-up duration:12 months). The control level of blood pressure,risk factors and the incidence of hypertension of the two groups were observed.ResultsAfter 12-month follow-up,patients compliance in comprehensive management group was significantly higher than that of general therapy group(P<0.001). Incidence of adverse reactions in comprehensive management group was less than that of general therapy group with a statistical significance(P<0.001). Total significant effective rate of blood pressure control in comprehensive management group was significantly higher than that in general therapy group,with systolic blood pressure,diastolic blood pressure further improved(P<0.001). As compared to general therapy group,in comprehensive management group,proportion of patients with smoking and drinking decreased significantly(P<0.001),basic body index(body mass index,waist circumference)decreased significantly(P<0.001),dyslipidemia improved(P<0.001),proportion of patients regularly taking antihypertensive drugs and monitoring their blood pressure increased(P<0.001). Overall incidence of complications in comprehensive treatment group was significantly lower than that in general therapy group(4.7% vs. 9.4%,P<0.001),including stroke,heart failure,coronary heart disease.ConclusionsStandardization management of hypertension in community is effective in improving hypertension treatment in the grass-roots community,which is thus worth popularizing.
ObjectivesTo investigate the influence of comprehensive prevention and control measures on the control of hypertension of patients from grass-roots community.MethodsTotally 2 383 cases of newly diagnosed hypertension patients were collected from July 2012 to July 2013 in the tertiary and 6 community hospitals in Guangzhou,which were randomly divided into general therapy group and comprehensive management group. In general therapy group,the patients were treated by general administration of antihypertensive drugs,which was modulated according to blood pressure. In comprehensive management group:the groups from the tertiary and community hospitals collaborated and the patients were treated by the integrated health management model. The risk factors of hypertension were screened and were interfered as much as possible when the blood pressure was strictly controlled and followed up regularly(follow-up duration:12 months). The control level of blood pressure,risk factors and the incidence of hypertension of the two groups were observed.ResultsAfter 12-month follow-up,patients compliance in comprehensive management group was significantly higher than that of general therapy group(P<0.001). Incidence of adverse reactions in comprehensive management group was less than that of general therapy group with a statistical significance(P<0.001). Total significant effective rate of blood pressure control in comprehensive management group was significantly higher than that in general therapy group,with systolic blood pressure,diastolic blood pressure further improved(P<0.001). As compared to general therapy group,in comprehensive management group,proportion of patients with smoking and drinking decreased significantly(P<0.001),basic body index(body mass index,waist circumference)decreased significantly(P<0.001),dyslipidemia improved(P<0.001),proportion of patients regularly taking antihypertensive drugs and monitoring their blood pressure increased(P<0.001). Overall incidence of complications in comprehensive treatment group was significantly lower than that in general therapy group(4.7% vs. 9.4%,P<0.001),including stroke,heart failure,coronary heart disease.ConclusionsStandardization management of hypertension in community is effective in improving hypertension treatment in the grass-roots community,which is thus worth popularizing.
引文
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[4]中华人民共和国卫生部,中华人民共和国科学技术部,中华人民共和国国家统计局.中国居民营养与健康现状[OL].2004-10-12[2017-12-12].https://wenku.baidu.com/view/e5593b755acfa1c7aa00cc27.html.
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[7]MANCIA G,FAGARD R,NARKIEWICZ K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension;the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertens,2013,31(7):1281-1357.
[8]KAZUAKI S,KATSUYUK A,TOSHIRO F,et al.The Japanese Society of Hypertension guidelines for the management of hypertension(JSH 2014)[J].Hypertens Res,2014,37(4):291-300.
[9]MAC MAHON S,PETO R,CUTLER J,et al.Blood pressure,stroke,and coronary heart disease.Part I,prolonged differences in blood pressure:Prospective observational studies corrected for the regression dilution bias[J].Lancet,1990,335(8692):765-774.
[10]KEARNEY P M,WHELTON M,REYNOLDS K,et al.Global burden of hypertension:analysis of worldwide data[J].Lancet,2005,365(9455):217-223.
[11]HACKAM D G,QUINN R R,RAVANI P,et al.The 2013Canadian Hypertension Education Program recommendations for blood pressure measurement,diagnosis,assessment of risk,prevention,and treatment of hypertension[J].Can J Cardiol,2013,29(5):528-542.
[12]尤川梅,熊先军,吴月华,等.社区高血压控制效果及其影响因素分析[J].中国卫生事业管理,2010,27(8):513-517.
[13]关卫文,刘伟光,司徒伟勤.开平地区抗高血压口服药物应用情况与药学服务干预效果[J].今日药学,2018,28(5):352-354+360.
[14]王增武,王馨,王文,等.中国部分省市社区高血压患者血压控制状况及影响因素分析[J].中华流行病学杂志,2012,33(9):903-906.
[15]赵欣,李瑞杰,徐应军.高血压病社区医院之间危险度分级管理模式的效果[J].临床荟萃,2010,25(6):42-45.
[16]徐燕.中国社区医师:医学专业[J].2010,12(10):166-167.2018-03-26
[2]GUIMARON S,GUIHAIRE J,AMSALLEM M,et al.Current knowledge and recent advances of right ventricular molecular biology and metabolism from congenital heart disease to chronic pulmonary hypertension[J].Biomed Res Int,2018,2018:1981568.
[3]LO G H.Endoscopic treatments for portal hypertension[J].Hepatol Int,2018,12(Suppl 1):91-101.
[4]中华人民共和国卫生部,中华人民共和国科学技术部,中华人民共和国国家统计局.中国居民营养与健康现状[OL].2004-10-12[2017-12-12].https://wenku.baidu.com/view/e5593b755acfa1c7aa00cc27.html.
[5]AL-ANSARY L A,TRICCO A C,ADI Y,et al.A systematic review of recent clinical practice guidelines on the diagnosis,assessment and management of hypertension[J].PLoS One,2013,8(1):e53744.
[6]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[7]MANCIA G,FAGARD R,NARKIEWICZ K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension;the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertens,2013,31(7):1281-1357.
[8]KAZUAKI S,KATSUYUK A,TOSHIRO F,et al.The Japanese Society of Hypertension guidelines for the management of hypertension(JSH 2014)[J].Hypertens Res,2014,37(4):291-300.
[9]MAC MAHON S,PETO R,CUTLER J,et al.Blood pressure,stroke,and coronary heart disease.Part I,prolonged differences in blood pressure:Prospective observational studies corrected for the regression dilution bias[J].Lancet,1990,335(8692):765-774.
[10]KEARNEY P M,WHELTON M,REYNOLDS K,et al.Global burden of hypertension:analysis of worldwide data[J].Lancet,2005,365(9455):217-223.
[11]HACKAM D G,QUINN R R,RAVANI P,et al.The 2013Canadian Hypertension Education Program recommendations for blood pressure measurement,diagnosis,assessment of risk,prevention,and treatment of hypertension[J].Can J Cardiol,2013,29(5):528-542.
[12]尤川梅,熊先军,吴月华,等.社区高血压控制效果及其影响因素分析[J].中国卫生事业管理,2010,27(8):513-517.
[13]关卫文,刘伟光,司徒伟勤.开平地区抗高血压口服药物应用情况与药学服务干预效果[J].今日药学,2018,28(5):352-354+360.
[14]王增武,王馨,王文,等.中国部分省市社区高血压患者血压控制状况及影响因素分析[J].中华流行病学杂志,2012,33(9):903-906.
[15]赵欣,李瑞杰,徐应军.高血压病社区医院之间危险度分级管理模式的效果[J].临床荟萃,2010,25(6):42-45.
[16]徐燕.中国社区医师:医学专业[J].2010,12(10):166-167.2018-03-26