医院-社区一体化管理模式对老年高血压并糖尿病患者自我管理能力的影响

Effect of Hospital-community Integrated Management Model on Self-management Ability of Elderly Patients with Hypertension and Diabetes Mellitus

目的:探讨医院-社区一体化管理模式对老年高血压并糖尿病患者自我管理能力的影响。方法:采用随机抽样方法选取本院2013年1月-2015年1月老年高血压并糖尿病患者116例作为研究对象,采用随机数字表法将其分为两组,每组58例,观察组采用医院-社区一体化管理模式,对照组采用传统单一社区管理模式,比较两组死亡、住院、血压达标、血糖达标、并发症发生及自我管理能力的差异。结果:观察组总体死亡率与心力衰竭死亡率稍低于对照组,但比较差异无统计学意义(P>0.05);观察组总体住院率与心力衰竭住院率明显低于对照组,比较差异具有统计学意义(P<0.05);观察组血压达标率及血糖达标率明显高于对照组,并发症总发生率明显低于对照组,比较差异均有统计学意义(P<0.05);观察组遵医嘱规律服药率、血压血糖自我监测率、适量运动率及合理饮食率等自我管理能力指标均明显高于对照组,比较差异均有统计学意义(P<0.05)。结论:医院-社区一体化管理模式有助于稳定控制老年高血压并糖尿病患者的血压与血糖指标,降低并发症发生风险,提高自我管理能力,值得临床推广应用。

Objective： To explore the effect of hospital-community integrated management model on self-management ability of elderly patients with hypertension and diabetes mellitus.Method： 116 patients with hypertension and diabetes mellitus were selected as the research objects by random sampling method.AU patients were divided into two groups by randomnumbertable method, with 58 cases in each group.The observation group was given hospital-community integrated management model, the control group was given traditional single community management mode.The differences in death, hospitalization, blood pressure up to standards, blood glucose reach standards, incidence of complications and self management ability of the two groups were compared. Result： The overall mortality and heart failure mortality of the observation group were lower than those of the control group, but the differences were not statistically significant （ P〉0.05 ） .The overall hospitalization rate and heart failure hospitalization rate of the observation group were lower than those of the control group, the differences were statistically significant （ P〈0.05 ） .The control rates of blood pressure and blood glucose of the observation group were significantly higher than those of the control group, the incidence rate of total complications in the observation group was significantly lower than that in the control group, the differences were all statistically significant （ P〈0.05 ） .The self management ability indexes such as compliance rate of medical treatment, monitoring rate of blood pressure and blood glucose, proper exercise rate and reasonable diet rate in the observation group were significantly higher than those in the control group, the differences were statistically significant （P〈0.05） . Conclusion： Hospital-community integrated management model is helpful to control blood pressure＇ and blood glucose, reduce the risk of complications and improve the self-management ability for elderly patients with hypertension and diabetes, it is worthy of clinical application.