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目的观察责任医师指导团体交流管理模式对社区高血压的管控效果。方法选择上海浦东沪东社区常住高血压患者318例作为研究对象,入组前先对患者进行基线调查,然后按照责任医师指导团体交流管理模式进行管理,干预1年后进行效果评估,比较干预前后“三率”变化(知晓率、服药率、控制率)、血压达标情况、高血压危险因素变化情况、参加健康教育情况、满意度情况差异。结果管理前、后知晓率(55.97%和100.00%)、服药率(52.20%和93.95%)、控制率(42.14%和88.22%),管理后均较管理前明显提高,差异有统计学意义(均P<0.01);管理后血压达标比例为70.06%,明显高于管理前34.91%,差异有统计学意义(χ2=84.818,P<0.01);管理后高血压危险因素高盐饮食、缺乏运动、吸烟、酗酒的比例较管理前明显降低,差异有统计学意义(P<0.01);管理后参加健康教育比例为48.09%,对社区责任医师的满意度为98.09%,均较管理前明显提高,差异有统计学意义(P<0.01)。结论责任医师指导团体交流管理模式能够有效提高社区高血压管理效率,有效改善“三率”及相关危险因素控制率,提高社区高血压病人血压控制达标率。
Objective To observe the effect of the responsible physician-guided group exchange management on community-based hypertension. Methods A total of 318 hypertensive patients with hypertension in Shanghai Pudong Hudong community were enrolled in this study. Before enrolling, patients were surveyed at baseline and then managed according to the exchange management mode guided by the responsible physician. One year after the intervention, the effect was evaluated. “Three rate ” changes (awareness, medication rate, control rate), blood pressure compliance, changes in risk factors for hypertension, participation in health education, satisfaction differences. Results Before and after the management, the rates of awareness (55.97% and 100.00%), the medication rates (52.20% and 93.95%) and the control rates (42.14% and 88.22%) were significantly higher after administration than those before management (P <0.01). After administration, the blood pressure compliance rate was 70.06%, which was significantly higher than that before management (34.91%), the difference was statistically significant (χ2 = 84.818, P <0.01) (P <0.01). The percentage of students who participated in health education after management was 48.09%, and their satisfaction with community-responsible physicians was 98.09%, which were significantly higher than those before management , The difference was statistically significant (P <0.01). Conclusion Responsible physicians guide the exchange management of community groups can effectively improve the management efficiency of community hypertension and effectively improve the control rate of “three rates” and related risk factors and improve the compliance rate of blood pressure control in community hypertensive patients.