张江区域家庭医生干预在社区原发性高血压患者中的应用效果观察

Application Effect Observation of Family Doctor Intervention in Community Patients with Primary Hypertension in Zhangjiang Area

目的:探讨张江区域家庭医生干预在社区原发性高血压患者中的应用效果。方法:选取2018年7月—2019年6月在上海市浦东新区张江社区卫生服务中心签约、就诊、随访的原发性高血压患者1 030例为研究对象,根据年龄段分为低龄组(35~45岁,n=330)、中龄组(46~59岁,n=345)、高龄组(≥60岁,n=355)。家庭医生对患者进行36个月的干预,比较不同年龄段患者的干预效果。结果:干预后,三组高血压知识掌握率和危险因素知晓率均高于干预前,差异有统计学意义(P<0.05)。低龄组干预前后低盐饮食率、体育锻炼率、服药依从性比较,差异无统计学意义(P>0.05)。中龄组干预前后低盐饮食率比较,差异无统计学意义(P>0.05);干预后,中龄组体育锻炼率、服药依从性高于干预前,差异有统计学意义(P<0.05)。干预后,高龄组低盐饮食率、体育锻炼率、服药依从性均高于干预前,差异有统计学意义(P<0.05)。低龄组、高龄组干预前后血压控制率比较,差异无统计学意义(P>0.05);干预后,中龄组血压控制率高于干预前,差异有统计学意义(P<0.05)。结论:家庭医生干预能明显提高中青年高血压患者相关知识掌握率、知晓率;对于35~45岁和≥60岁的患者,家庭医生还应继续在饮食、相关行为、服药依从性方面通过多种渠道加强长期干预,以提高血压控制率。

Objective:To investigate the application effect of family doctor intervention in community patients with primary hypertension in Zhangjiang area.Methods:A total of 1 030 patients with primary hypertension who were contracted,treated and followed up in Shanghai Pudong New Area Zhangjiang Community Health Service Center from July 2018 to June 2019 were selected as the study subjects.According to the age group,they were divided into the younger group(35-45 years old,n=330),the middle-aged group(46-59 years old,n=345),and the elderly group(≥60 years old,n=355).Family doctors performed 36-month intervention to patients and the effects of interventions in patients at different ages were compared.Results:After the intervention,the knowledge mastery rate of hypertension and the risk factor awareness rate in three groups were higher than those before the intervention,and the difference was statistically significant(P<0.05).There were no significant differences in the rates of low-salt diet,physical exercise and medication compliance before and after the intervention in the younger group(P>0.05).There was no significant difference in the rate of low-salt diet before and after intervention in the middle-aged group(P>0.05).After the intervention,the physical exercise rate and medication compliance in the middle-aged group were higher than those before the intervention,and the difference was statistically significant(P<0.05).After the intervention,the rates of low-salt diet,physical exercise and medication compliance in the elderly group were higher than those before the intervention,and the differences were statistically significant(P<0.05).There was no significant difference in the blood pressure control rate between the younger group and the elderly group before and after the intervention(P>0.05).After the intervention,the blood pressure control rate in the middle-aged group was higher than that before the intervention,and the difference was statistically significant(P<0.05).Conclusion:The intervention of family doctors can significantly increase the mastery rate and awareness rate of relevant knowledge of the young and middle-aged patients with hypertension.For patients at the age of 35-45 years and ≥60 years,family doctors should continue to strengthen long-term interventions on diet,related behaviors,and medication compliance through multiple channels to improve blood pressure control rate.