群组看病模式对社区高血压患者自我管理的影响研究

Influence of Group Medical Visits Model on Hypertension Self-management in Community

目的探索群组看病模式对社区高血压患者自我管理的影响。方法经社区动员,以上海某街道4个居委2011年1月—2012年12月签约管理自愿参与并符合标准的183例高血压患者为研究对象,按整群随机分组方法分为干预组(92例)和对照组(91例)。干预组患者以群组看病模式进行管理,对照组患者接受常规高血压管理。采用高血压群组看病问卷调查干预前、干预后3个月患者自我管理改变情况。结果干预前干预组和对照组服药依从性及身体活动依从性分布情况比较,差异无统计学意义(P>0.05);干预后干预组服药依从性和身体活动依从性分布情况比较,差异有统计学意义(P<0.05)。干预组干预后服药依从性和身体活动依从性均高于干预前(χ2=9.653、8.807,P<0.05);而对照组干预前后服药依从性和身体活动依从性比较,差异无统计学意义(χ2=0.389、1.626,P>0.05)。干预后干预组症状管理得分、疾病共性得分、社会支持得分、信任与参加得分均高于对照组(P<0.05)。干预组干预后症状管理得分、疾病共性得分、社会支持得分、信任与参加得分均高于干预前(P<0.05)。对照组干预前后症状管理得分、疾病共性得分、社会支持得分、归属感得分、信任与参加得分、互惠得分比较,差异均无统计学意义(P>0.05)。干预后干预组健康自评得分低于对照组(P<0.05)。干预前干预组收缩压高于对照组(P<0.05);而干预后两组比较,差异无统计学意义(P>0.05)。对照组干预前后健康自评得分、收缩压、舒张压比较,差异均无统计学意义(P>0.05);干预组干预后的健康自评得分、收缩压、舒张压均低于干预前(P<0.05)。干预组患者参与障碍的前3位因素分别为:是否有参与需求(40.2%)、时间和地点是否合理(39.1%)、家庭事务因素(32.6%)。结论高血压群组看病模式可以改善患者自我管理相关结局,并能提高患者满意度与参与意愿;进一步分析该模式的参与障碍和影响因素,有助于社区高血压患者的长效管理与可持续发展。

Objective To study the influence of group medical visits model on self-management on the hypertension patients. Methods From January 2011 to December 2012,183 hypertension patients meeting the inclusive standards were voluntarily involved in the study from four neighborhoods in a community of Shanghai after community mobilization. Then the subjects were divided into intervention group（ n = 92） and control group（ n = 91） by random cluster sampling method. The patients in the intervention group were managed with procedure of the group visits,while the control group was accepted with conventional hypertension management. Both groups were investigated about their self- management change by group medical visits questionnaire before intervention and 3 months after intervention. Results Before the intervention,the patients＇ distributions of medication compliance and physical activity compliance in the intervention group and control group were no statistically significant（ P 0. 05）,but they were significant after intervention（ P 0. 05）. Patients＇ medication compliance and physical activity compliance in intervention group were higher after intervention than before intervention（ χ2= 9. 653,8. 807,P 0. 05）; they were no significantly different in control group（ χ2= 0. 389,1. 626,P 0. 05）. After intervention,symptom management,social support self- efficacy,trust and participation had significant improvement in intervention group than those in control group（ P 0. 05）. They also had significant improvement in intervention group after intervention（ P 0. 05）,but no significant in control group and the differences of sense of belonging and reciprocity were no significant,too（ P 0. 05）. Self- rated health score was lower in intervention group than that in control group after intervention（ P 0. 05）. The systolic blood pressure was higher in intervention group than that in control group before intervention（ P 0. 05）,but after intervention,the difference was no significant（ P 0. 05）. Self- rated health score,systolic pressure and diastolic pressure in control group were no significant difference before and after intervention（ P 0. 05） and they were all lower in intervention group after intervention with significant difference（ P 0.05）. The first three factors influencing patients＇ participation were participation demands（ 40. 2%）,suitable time and places for the activities（ 39. 1%）,family affaires（ 32. 6%）. Conclusion The group medical visits of hypertension can improve the related self- management outcome,and the satisfaction as well as participation willingness of the patients. Further analysis of the participating barriers and influence factors contribute to the long- term and sustainable development of community hypertension management.