信息化医患互动平台在社区高血压患者管理中的效果

Effect of doctor-patient interaction based on information platform on hypertensive patients management in community

目的 探讨信息化医患互动平台对社区高血压患者自我效能与治疗依从性的影响。方法 采用方便抽样的方法纳入上海市青浦区华新镇社区高血压患者280例，根据患者意愿分为互动组（89例）和对照组（191例），对照组接受定期社区门诊随访，互动组在定期社区门诊随访的同时，参与基于信息化平台的医患互动，共干预3个月。干预前后采用高血压患者自我效能调查问卷、治疗依从性调查问卷对两组进行调查，分析互动方案的有效性。结果 干预前，两组患者自我效能总得分差异无统计学意义（t=1.635，P〉0.05），治疗依从性互动组[8.00（5.00）]低于对照组[10.00（3.00）]（Z= 4.409，P〈0.05）；干预后，互动组的自我效能总得分高于对照组[（34.42±4.49）分vs.（32.63±5.53）分，t= 2.867，P〈0.01]，治疗依从性差异无统计学意义（Z=0.784，P〉0.05）；各组干预前后自身比较发现，互动组社区高血压患者自我效能得分和治疗依从性有显著增强（P〈0.05），而对照组自我效能得分和治疗依从性干预前后差异无统计学意义（P〉0.05）。干预前，两组患者自我效能与治疗依从性（r=0.500）、服药依从性（r=0.327）、非药物治疗依从性（r=0.469）呈正相关（P均〈0.001）；干预后，两组患者自我效能与治疗依从性、服药依从性、非药物治疗依从性依然正相关（r〉0，P〈0.05），但相比于干预前，其相关系数有所降低，而健康行为、遵医行为与治疗依从性的相关系数有所提升。结论 信息化医患互动平台通过加强医患沟通等方式来增强患者的自我效能和治疗依从性，尤其在自我效能的健康行为、遵医行为与治疗依从性方面有加速改善的促进作用。

Objective To explore the effect of doctor-patient interaction based on information platform on hypertensive patients＇ self-efficacy and treatment compliance in community. Methods A convenience sampling method was used, and 280 patients with hypertension in Huaxin community health service centre were included. Patients were divided into interactive group （89 cases） and control group （191 cases） according to their wishes. Control group received a regular follow-up at community clinics, while interactive group participated in the doctor-patient interaction based on information platform at the same time of regular community clinic visit for 3 months. All patients were investigated using Self-efficacy Assessment Scale for Hypertensives and Treatment Compliance Questionnaire before and after intervention, which was used for effectiveness analysis. Results Before intervention, two groups showed no significant difference in self-efficacy （t=1.635, P〉0.05）, but there was significant difference in treatment compliance [interactive group：8.00（5.00） vs. control group：10.00（3.00）] （Z=4.409, P〈0.05）. After the intervention, two groups showed no significant difference in treatment compliance （Z=0.784, P〉0.05）, but there was significant difference in self-efficacy （interactive group：34.42±4.49 vs. control group：32.63 ±5.53）（t=2.867, P〈0.01）, which in interactive group was higher. Before and after the intervention, self-efficacy and the treatment compliance had significantly increased in interactive group （P〈0.05）. while not significantly increased in control group （P〉0.05）. Before intervention, there was a significant positive correlation between the total score of self-efficacy and treatment compliance（r=0.500, P〈0.001）, drug therapy compliance （r= 0.327, P〈0.001） and Non-drug treatment compliance （r=0.469, P〈0.001） in two groups, while there was lower positive correlation after intervention. Conclusion The doctor-patient interaction project of community hypertension supervision based on informatization platform is effective on the improvement of self-efficacy and the treatment compliance through the enhanced doctor-patient communication, particularly in promoting the role of self-efficacy to accelerate the improvement of health behaviors, compliance behavior and treatment compliance.