重庆市高血压和糖尿病患者社区健康管理现状及影响因素研究

Status of and Influencing Factors for the Community Health Management of Hypertensive and Diabetic Patients in Chongqing

目的了解重庆市高血压和糖尿病患者的社区健康管理现状,并探讨其影响因素。方法于2014年7月,采用方便抽样法,在重庆市沙坪坝区24个社区的社区卫生服务中心(站)中抽取居民1 200名。采用自行设计的问卷对纳入居民进行调查,内容包括居民的一般情况、慢性病患病情况及社区健康管理利用情况。共发放问卷1 200份,回收1 036份,因问卷填写不合格剔除15份,最终获得有效问卷1 021份。结果 1 021名居民的实际糖尿病患病率为11.9%〔122/1 021,95%CI(10.0%,13.9%)〕,实际高血压患病率为29.3%〔299/1 021,95%CI(26.5%,32.1%)〕。居民对社区健康管理的知晓率为77.8%(794/1 021),不同患病情况居民的知晓率比较,差异有统计学意义(P<0.05)。居民的社区健康管理接受率63.8%(651/1 021),不同患病情况居民接受率比较,差异有统计学意义(P<0.05)。不同患病情况居民对健康管理作用的认知、健康管理满意度、健康管理形式比较,差异无统计学意义(P>0.05)。健康管理内容中,不同患病情况居民在测量/询问血压和血糖、生活指导、用药指导、体格检查、建立健康档案及其他方面比较,差异有统计学意义(P<0.05);而在随访和健康教育讲座方面比较,差异无统计学意义(P>0.05)。多因素非条件Logistic逐步回归分析显示,性别、年龄、自测血糖和血压情况、最近卫生服务机构、患病情况对居民接受社区健康管理的影响有统计学意义(P<0.05)。结论居民的高血压和糖尿病患病率较高,而社区健康管理知晓率和接受率较低,高血压和糖尿病患者优于未患病居民。性别、年龄、自测血糖和血压情况、最近卫生服务机构、患病情况是居民接受社区健康管理的影响因素。

Objective To investigate the status of community health management of hypertensive and diabetic patients in Chongqing and its influencing factors. Methods In July 2014,we sampled 1 200 residents from 24 community health service centers in Shapingba District of Chongqing using convenience sampling method. We used a self- designed questionnaire to conduct investigation on the enrolled residents. The questionnaire content included general information,the condition of chronic diseases and the utilization of community health management. A total of 1 200 questionnaires were distributed and 1 036 questionnaire were returned,and we at last obtained 1 021 effective questionnaires after the exclusion of 15 unqualified questionnaires. Results The actual diabetes prevalence among the 1 021 residents was 11. 9% 〔122 /1 021,95% CI（ 10. 0%,13. 9%） 〕,and the actual hypertension prevalence was 29. 3%〔299/1 021,95%CI（ 26. 5%,32. 1%） 〕. The residents＇ awareness rate of community health management was 77. 8%（ 794/1 021）,and residents with different diseases were significantly different（ P〈0. 05） in the awareness rate. The residents＇ acceptation rate of community health management was 63. 8%（ 651 /1 021）,and residents with different diseases were significantly different（ P〈0. 05）in the acceptation rate. Residents with different diseases were not significantly different（ P〈0. 05） in the effect of health management,the satisfaction degree with health management and the form of health management. Among health management items,residents with different diseases were significantly different（ P〈0. 05） in blood pressure monitoring / consultation, life guidance, medication guidance,physical examination and the establishment of health record and other aspects; while residents with different diseases were not significantly different（ P〉0. 05） in follow- up and lectures of health education. Multivariate non- conditional logistic regression analysis showed that gender,age,monitor of blood glucose and blood pressure,the nearest health service setting and the state of illness had significant influence on residents accepting community health management（ P〈0. 05）. Conclusion Residents have higher prevalence of hypertension and diabetes mellitus,while the awareness rate and acceptation rate of community health management are low,and hypertensive patients and diabetic patients have higher awareness rate and acceptation rate. Gender,age,monitor of blood glucose and blood pressure,the nearest health service setting and the state of illness are influencing factors for residents accepting community health management.