社康中心开展慢性病综合管理的效果及其影响因素

Effect and influencing factors of comprehensive management of chronic diseases in community health center

目的探讨社康中心开展慢性病综合管理的效果及其影响因素。方法滚动式纳入2015年10月~2016年12月沙河社康中心就诊的慢性病患者,随访1年,观察组纳入500例,对照组纳入550例,评价研究对象的服药、运动、饮食、血压、血糖、血脂等指标和健康知识知晓率以及慢性病控制的情况,分析慢性病综合管理的影响因素。结果观察组的规律服药率、定期运动率、规律饮食和作息率、血压达标率、血糖达标率、血脂达标率、健康知识知晓率、疾病控制有效率高于对照组,差异均有统计学意义(P<0.05);饮食不规律、作息不规律、服药依从性差是影响慢性病控制效果的危险因素(P=0.000、0.041、0.015)。结论社康中心慢性病的管理效果好,而饮食不规律、作息不规律、服药依从性差是影响慢性病管理的危险因素。

Objective To explore the effect and influencing factors of the comprehensive management of chronic diseases in the community health center. Methods Chronic disease patients who were treated in Shahe Community Health Service Center from October 2015 to December 2016 were dynamically recruited and followed up for 1 year, among whom 500 cases were involved in observation group and 550 cases were involved in control group. Indicators such as medication, exercise, diet, blood pressure, blood glucose and blood lipids, as well as the health knowledge awareness rate and control of chronic diseases of all the subjects were evaluated. In addition, the influencing factors of comprehensive management of chronic diseases were analyzed. Results The regular medication rate, regular exercise rate, regular diet, work and rest rate, standard blood pressure rate, standard blood glucose rate, standard blood lipid rate, health knowledge awareness rate and effective disease control rate of observation group were higher than those of the control group, with statistically significant difference（P〈0.05）. The irregular diet, irregular work and rest, poor medication compliance were the risk factors for chronic disease control（P=0.000, 0.041, 0.015）. Conclusion The management of chronic diseases in the community health center is effective, while, irregular diet, irregular work and rest and poor medication compliance are the risk factors that influences the chronic disease management.