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目的探索社区高血压自我管理新模式,针对上海市某区社区高血压患者加以干预并进行效果评价。方法利用文献复习、专家讨论及相关利益方分析等方法,并结合当地实际探索社区高血压自我管理新模式。从知情同意,自愿参与干预的1.5万例高血压患者中随机抽取1 080例患者纳入干预组,并在各社区卫生服务中心高血压管理库中随机抽取未参与干预的588名患者作为对照组。通过协方差的秩和检验,比较干预组和对照组患者项目实施前和实施6个月之后在总体健康自评、获得卫生服务质量的评分等方面两次问卷调查数据的变化;通过协方差分析,比较两组患者血压的变化情况。结果相较对照组,干预组患者总体健康自评有明显改善(P<0.05)。干预组血压维持在较稳定状态,对照组较干预前舒张压升高,干预前后差异有统计学意义(P<0.05)。干预组与对照组相比,获得高血压病卫生服务质量方面,个人主动性和卫生服务提供系统设计等维度的评分6个月的增加值差异有统计学意义(P<0.05)。结论基于社区高血压自我管理新型模式的干预对改善高血压患者总体健康状况,稳定血压值,优化高血压服务质量有着积极的促进作用。
Objective To explore a new model of community hypertension self-management, to intervene and evaluate the effect of community hypertension in a certain area of Shanghai. Methods The methods of literature review, expert discussion and analysis of relevant stakeholders were used to explore a new mode of community self-management of hypertension based on the local situation. A total of 1080 patients were enrolled in the intervention group randomly from 15000 hypertensive patients with informed consent and voluntary intervention, and 588 patients without intervening intervention were randomly selected from the community health service center hypertension management database as the control group. Covariance rank sum test was used to compare the data of two questionnaires between the intervention group and the control group before the implementation of the project and after 6 months of implementation, in terms of overall health self-assessment, scores of obtaining health service quality, etc. By the analysis of covariance , Comparing the changes of blood pressure in two groups of patients. Results Compared with the control group, the overall health self-assessment of the intervention group was significantly improved (P <0.05). The blood pressure of the intervention group was maintained at a stable state, while the control group had higher diastolic blood pressure before intervention, the difference was statistically significant before and after the intervention (P <0.05). Compared with the control group, there was significant difference in the value added of six months in the quality of health service for hypertension, individual initiative and system design of health service (P <0.05). Conclusion Intervention based on community-based new model of hypertension self-management has a positive effect on improving overall health status, stabilizing blood pressure and optimizing service quality of hypertension.