健康管理中高血压治疗依从性的影响因素分析

Analysis of factors influencing treatment compliance of hypertensive patients in health management

目的 探讨健康管理中高血压治疗依从性的影响因素。方法 搜集2013年1月至2014年1月在我院健康管理中心体检的原发性高血压患者6 325例为干预组，其中男性4 132例，女性2 193例，年龄28~84岁，平均（61.2±5.8）岁，干预组的高血压患者随便分为3组（干预1组、干预2组及干预3组），均给予健康管理（包括体重管理、饮食管理、运动管理、服药管理及血压监测），3组客户分别给予每2个月1次、每月1次及每半月1次的电话随访及治疗依从性评价，将随访结果进行整合分析，分别按照受教育程度、年龄、心理状况进行分组比较；搜集同时期在我院心血管内科门诊就诊的1 892例高血压患者作为对照组，进行传统的门诊随访（门诊复查、健康宣教）、治疗依从性评价及纠正不正确的生活、服药方式及血压自测情况。采用方差分析和卡方检验分析比较两组的治疗依从性和血压控制率。 结果 干预组治疗依从性和血压控制率均高于对照组（64.6% vs. 41.3%，56.7% vs. 29.6%，χ2=2.827，1.382；P=0.032，0.007）。干预3组的治疗依从性和血压控制率高于干预2组和干预1组（77.3% vs. 65.4%，51.7%，χ2=3.414，P=0.041；69.6% vs. 57.3%，43.2%，χ2=2.763，P=0.028）。心理状态良好的患者的治疗依从性和血压达标率高于伴有焦虑症状和有焦虑倾向的患者（68.7% vs 59.1%，46.4%，χ2=3.257，P=0.037；60.1% vs 47.2%，32.8%，χ2=1.234，P=0.009）。本科及以上学历的患者治疗依从性及血压控制达标率明显高于大专、中学、小学及以下学历的患者（干预1组：64.3% vs. 55.1%，41.9%，31.0%，χ2=2.257 P=0.016；59.4%vs. 46.1%，20.9%，21.8%，χ2=3.345 P=0.021；干预2组：75.5% vs. 64.3%，51.8%，41.2%，χ2=2.932 P=0.030; 68.3% vs. 57.1%，39.2%，32.1%，χ2=2.382 P=0.032；干预3组：86.5% vs.73.2%，62.6%，52.4%，χ2=2.435 P=0.026; 75.2%vs. 68.0%，51.7%，43.3%，χ2=3.251 P= 0.036）。结论 更密集的随访可以提高高血压患者的治疗依从性及血压达标率；年龄、受教育程度及心理健康状况是影响高血压患者治疗依从性的因素。

Objective To analyze the factors which influence the treatment compliance of hypertensive patients in health management. Methods Data of 6 325 hypertensive patients who received physical examination in our department were collected; 4 132 male cases and 2 193 female were included, their ages ranged from 28 to 84 years old; the average age was 61.2± 5.8 years. The patients of the health intervention group were randomly divided into 3 groups （group 1, group 2 and group 3）. They were provided with regular health management （including weight management, catering management, sports management, medication management and monitoring of blood pressure）, respectively, given different frequency of telephone follow-up （1 time per 2 months, 1 time per month, and 1 time per month）, evaluating treatment compliance. All the results were analyzed and compared respectively according to the level of education, age and mental status. Data of 1 892 hypertensive patients who received outpatient services were enrolled as the control group. Among them, 4 132 were male and 2 193 were female, aged 28-84 years old, average （61.2 ＋ 5.8） years old, They received the traditional outpatient follow-up （outpatient service review and health education）, their treatment compliance, timely correcting unhealthy lifestyle and medication method andself-testing blood pressure were evaluated. ANOVA and chi square test were used to analyze the treatment compliances and blood pressure control rates of the two groups. Result Compared with the control group, health intervention for hypertension patients could significantly improve the treatment compliance and blood pressure control rate （64.8% vs. 41.3%, 56.7% vs. 29.6% ; X2=2.827, 1.382; P=0.032,0.007 ）. Comparing the results of telephone follow-up frequency, the treatment compliance and blood pressure control rate of the 3 intervention groups were higher than those of the two other groups （77.3% vs. 65.4%, 51.7%, X2=3.414, P= 0.041; 69.6% vs. 57.3%, 43.2%, X2=2.763, P=0.028）. The treatment compliance of patients with high education level was significantly higher than that of patients with low education level （68.7% vs. 59.1%, 46.4%, X：=3.257, P=0.037 ; 60.1% vs. 47.2%, 32.8%, X2=1.234, P=0.009）. And the treatment compliance of patients with good mental state was significantly higher than that of patients with anxiety （Intervention group1：64.3% vs. 55.1% ,41.9% ,31.0%,X2=2.257, P=0.016; 59.4% vs.46.1% ,20.9% ,21.8% ,X2=3.34 5 P= 0.021 ; Intervention group2 ： 75.5% vs. 64.3%, 51.8 %, 41.2 %, ~2=2.932, P=0.030 ; 68.3% vs.57.1%, 39.2%, 32.1%, X2=2.382, P=0.032; Intervention group3： 86.5% vs.73.2%, 62.6%, 52.4%, X2=2.435, P=0.026; 75.2% vs. 68.0% , 51.7% , 43.3% , X%3.251, P=0.036）. Conclusion More frequently follow-up can improve the treatment compliance and control rate of blood pressure in hypertensive patients; education, age and psychological condition are factors influencing treatment compliance in hypertensive patients.