河南省城市社区高血压糖尿病患者管理工作实施现状与分析

The Status and Analysis of the Health Management on Patients with Hypertension,Diabetes in Urban Community,Henan Province

目的掌握和分析河南省城市社区推广应用高血压、糖尿病综合防控适宜技术管理患者的现状。方法利用河南省33个城市社区卫生服务机构2007—2009年度的高血压、糖尿病综合防控适宜技术工作信息报表,采用SPSS 16.0软件进行统计分析。结果高血压、糖尿病患者管理率、控制率、规范服药率、双向转诊率和35岁首诊血压测量率分别由13.82%,68.53%,61.54%,57.69%和75.02%逐年提高至18.45%,76.61%,80.04%,53.33%和92.11%(P<0.05);管理患者的高血压、糖尿病主要并发症发生率、病死率逐年下降,如脑血管病、心脏病、冠心病、糖尿病足、肾病、眼部疾患由11.2%,10.89%,24.13%,2.99%,4.03%,7.68%。下降为3.3%,3.73%,5.72%,0.92%,1.42%,2.48%(P=0.000);患者的健康行为形成率得到逐步提高,如合理膳食、运动比率由68.82%,70.78%提高到75.01%,76.49%;吸烟率和饮酒率由34.57%和25.19%下降为20.97%和20.11%(P=0.000)。结论河南省城市社区实施了高血压、糖尿病患者规范化管理,提高了高血压、糖尿病控制率,降低了并发症的发生率。

Objective To know and analyze the management status of patients with hypertension and diabetes mellitus after application of appropriate techniques on the prevention and control in urban communities of Henan Province.Methods The 2007—2009 annual reports of the 33 community health service institutions in Henan Province were used,the management effects of the hypertension and diabetes were analyzed with SPSS 16.0.Results The rates of the management,control,standardized medication,first blood pressure detected aged 35 yrs and the patient’s health behavior formation were increased year by year（P= 0.000）;The incidences of major complications and mortality rate were declining（P =0.000）.Conclusion The Application of appropriate comprehensive prevention and control techniques for hypertension and diabetes in urban communities could effectively control of hypertension and diabetes,reduce the incidence of complications.