北京市城乡社区卫生服务中心高血压防治现状的对比研究

Comparison of the status in control of hypertension between rural and urban community health service centers in Beijing

目的了解北京市城乡社区卫生服务中心的高血压防治现状,为有针对性地指导其开展高血压防治工作提供参考。方法在北京市城乡分别抽取2个社区,对主要在社区卫生服务中心就诊的高血压患者(下称社区就诊患者)进行抽样问卷调查。共调查780人,用于本研究分析的资料完整者共761人。血压、身高和体重等指标均采用国际标准化方法进行测量。结果(1)血压控制率目前北京市社区就诊患者的血压控制率(血压<140/90mmHg,1mmHg=0133kPa)城乡分别为474%和246%,农村显著低于城市。(2)相关知识知晓率社区就诊患者对高血压诊断标准的知晓率城乡分别为304%和82%;对发病危险因素的知晓率(除精神紧张外)不超过20%;对冠心病和脑卒中以外的其他高血压主要并发症很少知晓。(3)检出途径出现高血压相关症状或发生了严重并发症后到医院检查时发现的高血压城乡分别为60%和70%。(4)药物治疗情况城乡社区就诊患者95%均接受药物治疗,治疗药物均以钙拮抗剂和复方制剂为主,利尿剂使用比例极低。(5)非药物治疗情况社区就诊患者接受非药物治疗的比例城乡分别为716%和266%。农村患者自述医生曾为其提供过非药物治疗建议的比例约12%,显著低于城市患者。(6)患者随访情况城乡分别只有21%和36%,社区就诊患者的随诊是医生要求的。结论北京市城乡社区?

Objective To find out and compare the current status in control of hypertension between rural and urban community health services in Beijing Methods A cross sectional study was carried out in August 2002 By using a typical sampling method, four comparable community health service centers were selected. Seven hundred and eighty hypertensives who consecutively visited the four centers in 2 weeks and met the inclusion criteria were surveyed Among them, Seven hundred and sixty one were eligible for analysis. Survey items covered four aspects of detection, treatment, management, and prevention of hypertension Statistical analyses were carried out using SPSS10 0 software package. Results (1) There were 47 4% and 24 6% of patients, respectively in urban and rural, with both SBP and DBP under control (less than 140/90 mm Hg), significantly lower in rural patients. (2) Only 30 4% urban patients and 8 2% rural patients could tell the diagnostic criteria of hypertension correctly The rates of awareness of major risk factors and complications of hypertension in urban and rural patients were also pretty low, especially in rural patients (3) There were 60% and 70% of patients had their hypertension being detected after the overt symptoms or hypertension related diseases onset (4)The percentages of patients who actually received drug treatment at the time of survey were 96 1% and 94 8% respectively in urban and rural areas With reference to the types of antihypertensive drugs, the two most popular medicines were calcium antagonists and local fixed dose combination, accounting for over 80% both in urban and rural patients The percentage of patients who used diuretics was very low, especially in rural patients The percentages of urban patients who were provided with suggestions on “appropriate diet”, “stress management”, and “physical exercises” were all over 60%, however, the corresponding percentages in rural patients were 11 7%, 11 8%, and 11 2% respectively Among overweight and obese patients, only 52 4% urban patients and 5 6% rural patients had ever been suggested to lose weight (5) There were 81 3% urban patients and 76 9% rural patients said they could visit doctor for follow up regularly Only 2 1% and 3 6% did it on the request of their doctors in urban and rural areas respectively Conclusions There are many insufficiencies in the work of prevention, detection, treatment and follow up of hypertension in both urban and rural community health services, especially in the aspects of providing suggestions on lifestyle modification and giving appropriate antihypertensive medications, which greatly needs to be strengthened and improved in the near future