家庭医生制度下社区高血压管理路径与效果分析

Analysis of the Route and Effect of GP System in the Hypertension Control

目的探讨家庭医生制度在高血压管理中的路径,分析家庭医生制度实施半年后高血压管理的效果。方法采用大样本抽样调查方式,采集高血压管理数据库资料,比较家庭医生制度实施前后高血压登记率、管理率、规范管理率、血压有效控制率以及认知率、随访率和服药率变化情况。结果实施家庭医生制度后,高血压登记率由71.6%上升至77.5%,管理率由58.4%上升至65.6%,规范管理率由44.0%上升至53.6%,血压有效控制率由42.2%上升至58.7%,认知率由71.3%上升至80.1%,随访率由93.4%上升至99.6%,服药率由69.7%上升至80.8%,七项指标均明显上升,认知率、随访率和服药率差异有统计学意义(P<0.05)。结论家庭医生制度下的高血压管理有利于提升高血压管理的效果,值得推广应用。

OBJECTIVE To explore the route of hypertension control for general practitioner system and analysis its effect of hypertension control half a year after the system was implemented. METHOD It got sample investigation in a large scale, collected information of hypertension control from the data bank, compared relevant charges of effective hypertension record ratio, management ratio, standard management ratio, hypertension control ratio, identification ratio, follow up ratio and medicine-taking ratio before and after the implementation of GP system. RESULT GP system had been implemented, hypertension record ratio rose from 71.6% to 77.5%, management ratio rose from 58.4% to 66.6%, standard management ratio rose up from 44.0% to 53.6%, effective hypertension control ratio rose from 42.2% to 58.7%, identification ratio rose up from 71.3% to 80.1%, follow up ratio rose up from 93.4% to 99.6% and medicine-taking ratio rose up 69.7% to 80.8%. All of 7 indicators obviously went upward. The difference of identification ratio, follow up ratio and medicine-taking ratio were of statistical significance. CONCLUSION The hypertension control under the GP system is apparently conductive to increasing the effect of hypertension control so that it is worthy of wide introduction and application.