云南省某贫困县高血压、糖尿病患者社区综合干预管理效果分析

An Evaluation of Effectiveness of the Community-based Comprehensive Intervention for Hypertension and Diabetes in a Rural County of Yunnan Province

目的掌握和分析云南省某贫困县高血压与糖尿病患者的社区综合干预管理实施现状,并进行效果评估,为农村社区高血压、糖尿病的综合防治提供参考依据.方法从慢病档案管理系统中收集2010年与2013年该社区高血压、糖尿病患者的相关指标,比较并分析干预前后各指标的变化情况,采用SPSS软件进行统计分析.结果采取综合干预管理以后,无论是高血压患者、糖尿病患者、高血压和糖尿病共患者的随访完成率,健康教育率,规律服药率,坚持运动率,整体控制率P<0.05.结论在农村地区开展社区综合干预管理确实可行,能够有效控制高血压、糖尿病,提高居民健康水平,可作为一种慢性病防治的重要手段和措施加以推广应用.

Objective To evaluate the effectiveness of the community-based comprehensive intervention for hypertension and diabetes in a rural county of Yunnan,and to provide the relevant evidences for policy making.Methods We systematically collected and analyzed the relevant data from computer-based information management system for chronic diseases.The SPSS was used for data analysis.Results The evaluation research showed that the community-based comprehensive intervention for hypertension and diabetes worked well in the county.The control rate of hypertension,diabetes and the both had been improved greatly,meanwhile,other relevant indicators,such as the regular medication rate,follow-up rate and satisfaction rate were also improved significantly.Conclusion The community-based comprehensive intervention for hypertension and diabetes is a feasible andeffective approach for chronic disease control and management in rural districts in China.