城市门诊医生对家庭血压监测的认知与行为模式调查

The awareness and behavior model of outpatient doctors in cities for home blood pressure monitoring

目的了解城市门诊医生对于家庭血压监测(HBPM)的认知情况及行为模式。方法采用便利取样法,自2013年5月至8月在北京、杭州、广州三城市的23家医院和社区卫生中心对门诊医生进行横截面问卷调查。问卷包含年龄、性别等基本信息,涵盖HBPM的价值、意义,诊断高血压的收缩压/舒张压水平,早晚血压测量值的重要性,推荐测量的时机、频度及方法等问题。结果调查共计发放问卷204份,回收194份(应答率95.1%)。男性39人(20.1%),女性155人(79.9%),平均年龄39.7岁。其中来自三级医院医生102人(52.6%),二级医院10人(5.1%),一级医院及社区卫生中心82人(42.3%)。49.5%(96/194)的医生认为HBPM与诊室血压或动态血压监测同等重要,31.4%(61/194)的医生认为HBPM更重要;81.4%(158/194)认为HBPM早、晚血压测量值均重要。95.9%(186/194)的医生认同HBPM可以提高高血压的知晓率,82.5%(160/194)认为HBPM有助于提高诊断的准确性,83.5%(162/194)认为可以提高对患者预后判断的准确性。仅34.0%(66/194)的医生能准确回答HBPM诊断高血压的收缩压/舒张压标准值(≥135/85mm Hg),51.0%(99/194)选择≥140/90mm Hg(诊室高血压诊断标准)。85.6%(166/194)的医生在患者就诊时建议进行HBPM,85.6%(166/194)建议采用上臂式电子血压计,94.8%(184/194)推荐至少每日测量1次,74.2%(144/194)建议起床后和睡觉前测量,43.3%(84/194)建议每次测量2遍,53.6%(104/194)建议测量3遍。32.5%(56/194)建议记录第2、3个读数的平均值,40.7%(79/194)建议记录所有读数的平均值。结论城市门诊医生诊疗中对HBPM的推荐的行为模式基本符合指南与共识,但认知水平仍有待提高。亟需加强教育与培训以改进对血压测量和监测的认知及行为模式。

Objective To investigate the awareness and behavior model for home blood pressure monitoring （HBPM） among outpatient doctors in cities. Methods Convenience sampling was used to collect cross-sectional questionnaires of outpatient doctors from 23 hospitals or community-based clinics in Beijing, Hangzhou and Guang- zhou from May to August 2013. The questionnaires included age, gender and other basic information and involved the value and significance of HBPM, the cut-points of systolic and diastolic pressure for diagnosis on hypertension, attitude on significance of morning or nocturnal blood pressure values, and time, frequency and methods of measur- ing. Results A total of 204 questionnaires were delivered during this survey, 194 subjects responded （response rate was 95.1%）. 39（20.1%）weremale, 155（79.9%）were female. Average age was 39.7 years old. 102（52.6%） doctors were from tertiary-level hospitals, 10（5.1%） from secondary-level hospital and 82 （42.3 %） from primary- level hospitals or community-based health care centers. 49.5 % （96/194） doctors regarded the equal importance of HBPM and office blood pressure measurement （OBPM） or ambulatory blood pressure monitoring, and 31.4% （61/194） considered HBPM more important; 81.4% （158/194） doctors considered the equal importance of HBPM during daytime and night. 95.9%（186/194）doctors acknowledged HBPM would help to improve the awareness of hypertension, 82.5% （160/194） believed HBPM could raise the accuracy of diagnosis, 83.5% （162/194） believed HBPM might help to improve accuracy of prediction of prognosis. Only 34.0% （66/194） doctors could correctly answer the cut-points of systolic blood pressure/diastolic blood pressure （≥135/85 mm Hg） for diagnosis of hypertension by HBPM, and 51.0M （99/194） choose ≥140/90 mm Hg （cut-points of OBPM）. 85.6% （166/194） doctors rec- ommended HBPM as patients visit, 85.6% （166/194） prefer arm-style electronic device, 94.8% （184/194） sugges- ted measuring at least once daily, 74.2%（144/194） advised measuring after getting up and before sleeping, 43.3% （84/194）proposed measuring twice and 53.6% （104/194）proposed measuring three times each time. 32.5%（56/ 194）doctors advised to record the average value of the second and third readings and 40.7% （79/194） doctors recom- mended to record the mean of all readings. Conclusion The behavior models on HBPM recommendations are ac- cordance to the guidelines and consensus statements, but the level of awareness are still low among outpatient doc- tors in cities, indicating a compelling need for education and training to improve the awareness and behaviors on blood pressure measurement and monitoring.