浙北农村高血压患者精细化自我管理干预效果分析

Efficiency of refined self-management intervention among hypertension patients in rural areas of northern Zhejiang province

目的探索浙北农村地区高血压患者精细化自我管理群组干预对改善生活方式和控制血压的影响,为高血压患者管理提供科学依据。方法于2016年1-3月采用整群随机抽样方法选取浙北农村地区1292例高血压患者入组研究,其中干预组625人参与精细化自我管理群组干预,对照组667人进行慢性病常规管理,干预期为1年。在干预前后进行问卷调查、体格检查和生化指标检测,采用SPSS19.0软件进行t检验、χ^2检验和双重差分法(DID)分析。结果干预1年后,干预组研究对象的服药率、每周蔬菜摄入频率分别从干预前的91.20%、92.96%上升到干预后的95.20%和96.48%,且差异均有统计学意义(P<0.05);收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、空腹血糖(FPG)、人均日味精、食盐摄入量、饮酒率干预前后差异均有统计学意义(P<0.05)。在调整性别、文化水平、职业、婚姻、医疗保险、年均收入等因素后,精细化自我管理干预措施的实施使得腰围(WC)、SBP、DBP、FPG、人均日吸烟量、人均日味精摄入量、人均日食盐摄入量和饮酒率等分别降低了3.06cm、6.36mmHg、2.75mmHg、1.40mmol/L、6.04支、1.04g、3.51g和8.3%,以及每周蔬菜摄入频率增加了5.6%,差异均有统计学意义(P<0.05)。结论浙北农村地区精细化自我管理群组干预能有效降低高血压人群的血压水平,同时对生活方式改善起到促进作用。

Objective To investigate the effect of refined self-management intervention on hypertension patients in rural areas of northern Zhejiang province and to provide evidences for hypertension patients management. Methods Using random cluster sampling, we recruited 1 292 hypertension patients registered at 8 township hospitals in a district of northern Zhejiang province during January-March 2016 and assigned them into an intervention group (cases: n = 625) with one-year refined self-management and a control group (controls: n = 667) with routine chronic disease management. Questionnaire interviews, physical examination, and laboratory detections were performed at the beginning and the ending of the intervention in all the participants. The difference-in-difference model (DID) was be used to evaluate the effect of the refined self-management intervention. Results By the end of the intervention, the cases reported significantly increased rates of taking medicine (95.20% vs. 91.20%) and consumption of vegetables every week (96.48% vs. 92.96%)(both P < 0.05) but significantly decreased rate of alcohol drinking, average personal daily consumption of gourmet powder and table salt (P < 0.05 for all);significantly decreased body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and fasting plasma glucose (FPG) were also detected among the cases after the intervention (P < 0.05 for all). After adjusting for gender, education, occupation, marital status, medical insurance, average annual income, the results of DID analysis revealed significant decreases in waist circumference (3.06 cm), SBP (6.36 mm Hg), DBP (2.75 mm Hg), FPG (1.40 mmol/L), number of cigarette smoked per day (6.04), average personal daily consumption of gourmet powder (1.04 g) and table salt (3.51 g), and rate of alcohol drinking (8.3%) but significant increase in the rate of vegetable consumption per week (5.6%)(all P < 0.05). Conclusion Refined self-management intervention could effectively control blood pressure and promote healthy lifestyle among hypertension patients in rural areas of northern Zhejiang province.