佛山市南海区社区健康管理模式对高血压患者干预效果评价

Intervention effect evaluation of community-based health service management mode on patients with hypertension in Nanhai District,Foshan

目的评价佛山市南海区高血压自我管理课程与健康生态学理论相结合的高血压社区健康管理模式对高血压人群的干预效果。方法选取已确诊且在社区已建立健康档案的高血压患者作为研究对象,随机分为干预组和对照组,干预组接受社区健康管理模式,对照组接受常规的基本公共卫生服务规范管理。比较2组高血压患者在项目实施前和实施6个月后的健康行为、自我管理效能、身体测量指标和血生化检查结果变化情况。结果共收集高血压患者412例,其中干预组212例,对照组200例,2组患者在性别、年龄、文化程度和病程差异均无统计学意义(均P>0.05)。项目实施6个月后,干预组和对照组在每天食盐摄入量、每周水果蔬菜摄入频率、每周运动次数、每周吸烟量和每周饮酒量的行为变化的构成情况差异均有统计学意义(P<0.05或P<0.01)。在自我管理效能、政策资源利用和医疗服务资源利用上,干预组在干预前后的构成差异均具有统计学意义(均P<0.01),对照组仅医疗服务资源利用在干预前后的构成差异具有统计学意义(P<0.01)。对照组的舒张压干预后低于干预前,干预组的收缩压、舒张压、腰围、空腹血糖、TC、TG干预后均低于干预前(均P<0.05)。干预组各项检查指标干预前后差值与对照组比较差异均具有统计学意义(均P<0.05)。结论本研究的社区高血压健康管理模式比较基本公共卫生服务规范管理模式,在改善患者生活方式相关行为、提高自我管理能力、增强患者充分利用社会政策资源和积极与医生沟通的能力、控制体重和腰围、降低血压血糖血脂、提高高血压控制率方面效果更为有效,建议此管理模式在社区中广泛应用。

Objective To evaluate the intervention effects of a community-based health service management mode,which used a combined regimen of Self-management Model and Health Ecological Medicine,on community patients with hypertension in Nanhai District,Foshan. Methods Patients with hypertension,whose health profile had been built in the community,were selected and randomized into intervention group and control group. The intervention group received the community-based health service management mode,while the control group received conventional basic public health service management. Changes of health behavior,self management efficiency,and parameters of physical examination and biochemical detection were compared between two groups before and after 6 months of the implementation of the project.Results A total of 412 patients with hypertension were selected,including 212 in the intervention group and 200 in the control group. There were no significant differences in gender,age,education level,and the course of hypertension between the intervention group and the control group（ all P〈0. 05）. Six months after implementation of the project,the differences in changes of daily salt intake,daily intake of fruits and vegetables,weekly physical exercises,weekly cigarette smoking,and weekly alcohol consumption were statistically significant between the two groups（ P〈0. 05 or P〈0. 01）. Before and after the intervention,the differences in proportions of the self-management efficiency,policy resource utilization,and utilization of medical service resource were statistically significant in the intervention group（ all P〈0. 01）,while only in the proportion of the utilization of medical services resource was statistically significant in the control group（ P〈0. 01）. After the intervention,the diastolic systolic blood pressure was lower in the control group; the systolic blood pressure,diastolic blood pressure,waist circumference,fasting blood-glucose,total cholesterol and triglyceride were lower in the intervention group（ all P〈0. 05）. The differences in all the parameters of examination and detection were also statistically significant different between the two groups before and after the interventions（ all P〈0. 05）. Conclusion Compared with conventional public health service management,the community-based health service management mode for patients with hypertension has better effects on the improvement of lifestyle-related behavior,self-management efficiency,utilization of community policy and medical service resources,body weight and waistline control,and lowering blood pressure,blood-glucose,and blood lipid. This health service management mode should be widely used in the community.