金华市社区高血压患者规范化管理效果评价

Effectiveness evaluation of standardized community-based hypertension management in Jinhua City

目的了解金华市实施社区高血压患者规范化管理前后，规范管理率、血压控制、生活方式的改变情况。方法选择金华市的市区、永康市、兰溪市各1-2个街道社区卫生服务中心（乡镇卫生院）在规范化管理后的辖区内在管的原发性高血压患者。本研究通过电子健康系统档案获取2015年首次随访记录以及2017年末次随访记录分别作为规范化管理前和规范化管理后的相关数据及指标；采用率和构成比等指标进行统计学描述，计数资料的比较采用χ2检验，均数比较采用t检验。结果14 943例规范化管理的高血压患者女性随访档案数共8 052例（53.88%），男性6 891例（46.12%）；2015年年初高血压管理患者平均年龄为66.63岁。经3年规范化管理，控制率由42.85%提高至49.50%，差异有统计学意义（χ2=133.019，P〈0.05）；收缩压、舒张压平均值（138.67 mmHg、84.46 mmHg）（1 mmHg=0.133 kPa）与规范化管理前比较（139.40 mmHg、85.08 mmHg）差异有统计学意义（t值分别为7.667、6.583，P均〈0.05）；体重、吸烟患者日吸烟量、规律运动者中每次运动时间（61.51 kg、15.28支、40.56 min）与规范化管理前（61.62 kg、15.49支、40.31 min）比较，差异有统计学意义（t值分别为5.015、1.848、2.455，P〈0.05）药物依从性、接受管理的程度有所提高，差异有统计学意义（χ2值分别为72.600、299.434，P〈0.05）。结论社区规范化管理能够有效提高患者血压控制率，对提高居民的整体健康水平，控制高血压的发展有重要的意义。

ObjectiveTo evaluate the effectiveness of community-based standardized blood pressure control and lifestyle management in hypertensive patients in Jinhua.MethodsThe study included patients with primary hypertension from community health service centers in Yongkang, Lanxi, and an urban district in Jinhua. Electronic health record data from 2015 to 2017 were collected, and relevant indicators before and after standardized management were assessed. Rates and constituent ratios were used for statistical evaluation. Numeric data were compared using the chi square test, and means were compared using the t-test.ResultsOf 14 943 hypertensive patients who underwent standardized management, 8 052 were women （53.88%） and 6 891 were men （46.12%）. The average age of these patients in early 2015 was 66.63 years. After 3 years of standardized management, the rate of blood pressure control increased from 42.85% to 49.50%. The difference was statistically significant （χ2=133.019, P〈0.05）. The mean systolic and diastolic blood pressure values （138.67 mmHg and 84.46 mmHg, respectively） （1 mmHg=0.133 kPa） after standardized management were significantly different from those （139.40 mmHg and 85.08 mmHg, respectively） before standardized management （t=7.667, P〈0.05; t=6.583, P〈0.05, respectively）. The average body weight, number of cigarettes smoked daily, and regular exercise time （61.51 kg, 15.28 cigarettes, and 40.56 min, respectively） after standardized management were significantly different from those （61.62 kg, 15.49 cigarettes, and 40.31 min, respectively） before standardized management （t=5.015, P〈0.05; t=1.848, P〈0.05; t=2.455, P〈0.05, respectively）. The medication compliance and willingness of being managed had significantly increased. The difference was statistically significant （χ2=72.600, P〈0.05; χ2=299.434, P〈0.05, respectively）.ConclusionsStandardized community-based management of hypertension effectively improved the rate of blood pressure control and the overall health of residents.