广州市白云街11个社区老年高血压患者就医状况调查

Survey on the status of receiving medical treatment in hypertension elders in 11 communities of Baiyun street of Guangzhou

目的:调查社区老年高血压患者就医状况,并分析其发病途径及就诊医院与病情控制的关系。方法:调查于2001-04/11在广州市东山区中医针灸门诊部完成。11个社区共筛查4015人,资料完整者3755人,符合纳入高血压标准676例。高血压患者的一般情况:①男326例(48.2%),女350例(51.8%),年龄60～95岁,平均(70.2±6.2)岁。②文化程度:文盲73例(10.8%),小学211例(31.2%),初中164例(24.3%),高中90例(13.3%),中专29例(4.3%),大专以上109例(16.1%)。③婚姻状况:未婚12例(1.8%),已婚517例(76.5%),离婚12例(1.8%),丧偶135例(20.0%)。④职业状况:工人47例(7.0%),干部111例(16.4%),经商9例(1.3%),离退休464例(68.6%),其他45例(6.7%)。在统一指导用语下采用入户访谈逐一登记方式,进行问卷调查。调查内容包括个人资料、医疗费用负担方式、疾病的初次发现方式及就医情况、病情控制情况。结果:纳入老年高血压患者676例,均进入结果分析。①疾病的发现途径:34.8%为体检时发现高血压,29.7%是治疗其他疾病时发现,35.5%为高血压引起不适而发现。②就诊医院分布情况:14.5%患者常于社区卫生站治疗,22.3%于区街医院治疗,53.3%于省市医院治疗,其它占9.9%。③检查治疗情况:有86.7%患者接受长期治疗,82.1%患者会定期检查,病情控制率为98.0%。④医疗费用负担方式:公费医疗42.2%,劳保41.7%,统筹医疗12.1%,医疗保险0.6%,自费12.9%,其他0.6%。⑤治疗不同地点与目前病情状况:在省市医院求治好转率39.4%,稳定率58.6%,恶化率1.9%;在社区卫生站求治好转率80.6%,稳定率18.4%,恶化率1.0%。结论:本次调查中社区老年人高血压发现率约1/3在体检时发现,说明老年人有了疾病预防的观念。并且近90%的患者可定期检查和坚持长期治疗,使病情控制率达98%。数据中显示在区级以下医院患者病情好转率相对较高,分析原因可能与去治疗者的病情较轻有关。但同时提示坚持在社区基层医疗机构求治,可以对老年高血压的预防、发现、治疗起到很好的控制作用。

AIM： To investigate the situation of receiving medical treatment in hypertension elders in the community, and analyze the relation of their way of episode and hospitalization hospital with the control of patient＇s condition.METHODS： The investigation waS done in Outpatient Department of Traditional Chinese Medical Acupuncture and Moxibustion of Dongshan District of Guangzhou between April 2001 and November.4 015 people from 11 communities were selected with 3 755 people having full material and 676 caSes were accorded with hypertension inclusion criteria.The general condition of hypertension patients： ① 326 male cases （48.2%）, 350 female caSes （51.8%）, aged from 60 to 95 years old, averaged（70.2±6.2） years old.② Level of culture： Seventy-three illiteracy cases （ 10.8% ）, 211 elementary school caSes （31.2%）, 164 middle school cases （24.3%）, 90 high school caSes （13.3%）, 29 technical secondary school cases （4.3%）, 109 over junior college cases （16.1%）. ③ Marriage status： Twelve unmarried cases （1.8%）, 517 married cases （76.5%）, 12 divorce cases （1.8%）, 135 lose spouse cases （20.0%）. ④ Professional status： Fortyseven worker （7.0%）, 111 cadre cases （ 16.4% ）, 9 merchant cases （1.3%）, 464 dimission cases （68.6%）, 45 others （6.7%）.Under unification instruction phraseology questionnaire investigation was conducted with the method of talking and enrollment one by one. The investigation content included individual material, onus of medical cost, first disease detection method and the condition of hospitalization and control of patient＇s state. RESULTS： 676 hypertension elders were all involved ＇in the result analysis. ① The way of discovering the disease： 34.8% of them discovered the hypertension when performed health examination.29.7% of them discovered the hypertension when treated other diseases.35.5% of them discovered the hypertension when malaise brought by hyperten sionoccurred. ② The distribution condition of hospitalization hospital： 14.5% of the patients always treated in health plant of community. 22.3% of the patients always treated in hospital of district or street. 53.3% of the patients always treated in city hospital. 9.9% other ways. ③ Condition ofcheck and treatment： 86.7% of the patients accepted long-term treatment. 82.1% of the patients had regular check. The control rate of patient＇s condition waS 98.0%. ④ The onus way of medical cost： 42.2% of them were public medical care. 41.7% of them were labor insurance. 12.1% of them were making overall plans medicine. 0.6% of them medical insurance. 12.9% of them were at one＇s own expense, and 0.6% others. ⑤ The different treatment site and the patient＇s condition at present： Those treated in provincial and city hospital with 39.4% improving rate, 58.6% stable rate and 1.9% worsen rate; Those treated in health plant of community with 80,6% im proving rate, 18.4% stable rate and 1.0% worsen rate. CONCLUSION： In this investigation one third of the hypertension elders from community discover the disease when check the health examination, which indicates that the elders already have the idea of disease prevention. Moreover, nearly 90% of the patients can make regular examination and insist long-term treatment, which make the control rate of patient＇s condition reach 98%. The data shows that the improved rate of patient＇s condition treated in under-district grade hospital is relatively higher, and the reason after analysis may be have concerning the more light state of an illness in patients. However, it is indicated that if insist treating in basic medical establishment of community may have good control effect on the prevention, discovery and treatment of hypertension in elders.