家庭自测血压对社区高血压患者血压控制和治疗依从性的影响

The effect of home blood pressure monitoring on blood pressure control and treatment compliance in community patients

目的探讨家庭自测血压对社区高血压患者血压控制和治疗依从性的影响。方法选择2015年1月至2016年1月四川省广汉市10个社区卫生服务中心门诊的5 000例高血压患者作为研究对象,研究共分为3个阶段。第一阶段:患者进行高血压健康宣教以及药物干预,实施自我管理,患者在家自行检测血压并记录,定期至社区随诊,根据血压控制情况调整治疗方案;第二阶段:对于第一阶段血压控制未达标的患者实施专人跟踪管理,由社区安排专人定期对患者进行随访,主动保持联系并指导治疗;第三阶段:对于第二阶段血压控制仍未达标的患者,按随机数字表法分为观察组和对照组,对照组干预措施与第二阶段相同,观察组则采用家庭自测血压自动记录与分析系统对高血压患者进行管理,采用智诊通专业血压测量仪(欧姆龙HEM-7080-IC)在家测量血压。观察各阶段高血压患者血压控制达标情况,2组患者干预前后血压水平以及血压控制达标率,采用高血压治疗依从性量表对患者的治疗依从性情况进行评分。结果第一阶段血压控制达标率为53.65%,第二阶段血压控制达标率为45.41%,未达标的1 256例进入第三阶段。观察组收缩压、舒张压水平均明显低于对照组(P<0.05);观察组血压控制达标率为60.35%,显著高于对照组的35.67%(P<0.01);观察组遵医服药行为、不良服药行为、日常生活管理行为、研究嗜好管理行为及量表总分均明显高于对照组(P<0.05)。结论优化家庭自测血压能够有效提高社区高血压患者血压控制达标率,降低血压水平,提高患者治疗依从性,这对于促进家庭血压监测的健康发展。

Objective To explore the effect of home blood pressure monitoring on blood pressure control and treatment compliance in community patients.Methods From January 2015 to January 2016,5 000 patients with hypertension treated at 10 community health service centers in Guanghan city were included.The experiment consisted of 3stages.In the first stage,the patients received hypertension education and medications.The education program was concerned with instructing on the method of home blood pressure monitoring and re-iterating the importance of paying regular follow-up visit to community healthy service centers,where the treatment plan was regulated according to the control status of hypertension.In the second stage,special staffs were assigned by the community for follow-up and providing guidance for these patients.In the third stage,patients who failed to reach the standard of hypertension control in the second stage were randomly divided into observation group and control group.The intervention as with the second stage was administered to the control group,while for the observation group,the automatic home blood pressure monitoring and analysis system was used（Omron automatic blood pressure monitor HEM-7080IC）.The standard reaching rate among these patients before and after intervention was compared.Treatment compliance was assessed using therapeutic adherence scale for hypertensive patients..Results The standard reaching rate of blood pressure in the first stage was 53.65%and that in the second stage was45.41%.A total of 1 256 patients failing to reach the standard were included to the third stage of experiment.The patients in the observation group had much lower mean systolic pressure and diastolic pressure compared with the control group（P〈0.05）.The standard reaching rate of the observation group was 60.35%,which was significantly higher compared with the control group（35.67%,P〈0.01）.The scores rated for the behavior of tak-ing medications as prescribed,poor medication taking behavior,daily life management,bad habit management and total scores were considerably higher in the observation group compared with the control group（P〈0.05）.Conclusion Optimizing home blood pressure monitoring can effectively increase the standard reaching rate of blood pressure among hypertension patients and enhance treatment compliance.Therefore,home blood pressure monitoring is significant for raising the treatment rate and control rate of hypertension.