社区高血压、糖尿病患者精细化管理效果调查

Effect investigation of delicacy management for the patients with hypertension and diabetics in community

目的评价社区高血压、糖尿病精细化管理效果,为制定慢性病防控策略提供参考。方法采用分层抽样的方法,随机抽取接受随访管理的高血压、糖尿病患者为调查对象,在规范管理的基础上实施精细化干预,干预前后进行问卷调查、体格测量和实验室检测。计量资料采用■表示,率的比较采用χ~2检验,干预前后指标比较采用t检验,以P<0.05为差异有统计学意义。结果共有来自3个镇/街道的667例高血压和糖尿病患者纳入调查,干预后高血压患者体重、收缩压、舒张压较干预前分别下降0.75kg、2.72mmHg和1.92mmHg,糖尿病患者体重、腰围较干预前分别降低0.80 kg和0.48kg/m^2。干预后患者饮酒率、吸烟率、缺乏运动率和高盐饮食率均较干预前降低,差异均有统计学意义(P<0.05);干预后高血压患者疾病知识知晓率由49.86%提高到79.82%,血压控制率由61.13%提高到72.11%,糖尿病患者疾病知识知晓率由46.06%提高到59.09%,血糖控制率由63.23%提高到70.30%,规律服药率由93.33%提高到96.69%,差异均有统计学意义(P<0.05)。结论基于患者自我管理理论的精细化管理可以改善患者生理和生化指标,控制危险因素,提高疾病相关知识知晓率,从而有效控制血压、血糖,值得进一步推广。

Objective To evaluate the effect of delicacy management for the patients with hypertension and diabetics,provide effective prevention and intervention strategies for chronic disease.Methods Stratified sampling was adopted to randomly select patients with hypertension and diabetes who received follow-up management as survey objects,and fine intervention was implemented on the basis of standardized management.Questionnaires,physical measurements and laboratory tests were conducted before and after the intervention.The measurement data were presented as ■,the rates were compared by Chi-square test,and the indexes before and after intervention were compared by paired t test.P<0.05 was considered statistically significant.Results Six hundred and sixty-seven patients from three towns were selected.After intervention,the levels of weight,diastolic and systolic blood pressure of the patients with hypertension were decreased by 0.75 kg,2.72 mmHg and 1.92 mmHg;the levels of weight and waist of the patients with diabetes were decreased by 0.80 kg and 0.48 kg/m^2;and for both type of patients,the rate of drinking,smoking,lack of exercise and high salt intaking were decreased(P<0.05).Before and after the intervention,the disease-related knowledge rate for the patients with hypertension were 49.86% and 79.26%,the blood pressure control rate were 61.13% and 72.11%;the disease-related knowledge rate for the patients with diabetics were 46.06% and 59.09%,the blood glucose control rate were 63.23% and 70.30%,the regular medication rate increased from 93.33% to 96.69%,the differences in rates were statistically significant.(P<0.05).Conclusion The delicacy management based on self-management theory can effectively improve the physiological and biochemical indexes,control dangerous factors,increase the disease-related knowledge,control blood pressure and blood glucose,it should be popularized continuously.