不同就诊方式的社区高血压患者血压控制效果及费用的比较研究

Effects and Expense of Blood Pressure Control on Hypertensive Patients Using Different Treatment Methods:A Comparative Study

目的比较不同就诊方式的社区高血压患者血压控制效果及降压药物费用。方法于2013年9—12月选取纳入社区高血压随访管理、但在二三级医院就诊并配取降压药物者79例为非社区就诊组,按照性别、年龄、体质指数(BMI)、文化程度、病程、危险分层、工作状态及医疗费用支出形式等进行1∶1配对,选取纳入社区高血压随访管理、亦在社区卫生服务机构就诊并配取降压药物者79例为社区就诊组。采用病人健康问卷(PHQ-9)对患者进行评估;调查患者的高血压危险因素知晓率、服药依从率及血压控制率,作为血压控制效果指标;并收集患者最近6个月的就诊次数、高血压医疗总费用、医保支付费用、自付费用、每月降压药物费用、均次费用及降压药物种类等。结果两组的PHQ-9得分比较,差异无统计学意义(P>0.05)。两组的高血压危险因素知晓率比较,差异无统计学意义(P>0.05);服药依从率和血压控制率比较,差异均有统计学意义(P<0.05)。两组的就诊次数比较,差异无统计学意义(P>0.05);高血压医疗总费用、医保支付费用、自付费用、每月降压药物费用及均次费用比较,差异均有统计学意义(P<0.05)。两组的钙拮抗剂、珍菊降压片的使用率比较,差异有统计学意义(P<0.05);利尿剂、β-受体阻滞剂、血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体阻滞剂及复方降压片的使用率比较,差异均无统计学意义(P>0.05)。结论在社区卫生服务机构就诊的高血压患者的服药依从性、血压控制率优于非社区就诊者,医疗费用低于非社区就诊者。

Objective To compare the effects of blood pressure control and the expense of antihypertensive drugs among patients using different treatment methods.Methods Between September to December in 2013,we enrolled 79 patients who were under the administration of community follow- up management on hypertension but received treatment and obtained antihypertensive drugs in the secondary or tertiary hospitals as non- community treatment group.By 1 ∶ 1 match in the aspects of gender,age, BMI, education level, course of disease, risk stratification, working condition and medical expense, we included 79 patients who were under the administration of community follow- up management on hypertension and received treatment and obtained antihypertensive drugs in community health service settings as community treatment group.PHQ-9 was adopted to conduct assessment on these patients.Patients＇ awareness rate of risk factors for hypertension, compliance to drug administration and blood pressure control rate were investigated as the indexes of blood pressure control effect; the number of visits to doctors,the total medical expense for hypertension treatment,the expense covered by medical insurance,self- paid expense,monthly expense for antihypertensive drugs,expense per time and categories of antihypertensive drugs in the past 6months were collected.Results The two groups were not significantly different in PHQ-9 score（ P〈0.05）.The two groups were not significantly different in patients＇ awareness rate of risk factors for hypertension（ P〈0.05）,and the two groups were significantly different in the rate of compliance to drug administration and blood pressure control rate（ P〉0.05）.The two groups were not significantly different in the number of visits to doctors（ P〈0.05）,and the two group were significantly different in the total medical expenses for hypertension treatment, the expense covered by medical insurance, self- paid expense, monthly expense for antihypertensive drugs and expense per time（ P〈0.05）.The two groups were significantly different in the usage rates of calcium antagonists and Zhenjujiangya tablets（ P〈0.05）, and the two groups were not significantly different in diuretics,β-receptor blocker,angiotensin converting enzyme inhibitor,angiotensinⅡ receptor blocker and compound reserpine（ P〈0.05）.Conclusion Patients who are treated in community health service settings have superior compliance to drug administration,higher blood pressure control rate and lower medical expense than patients who are treated in non- community medical settings.