云南省基本公共卫生服务管理高血压患者血压控制效果及影响因素

Effectiveness and influencing factors of blood pressure control among community hypertensive patients under disease management of basic public health services in Yunnan province

目的探讨云南省基本公共卫生服务管理下高血压患者的血压控制效果及其影响因素,为提升基本公共卫生服务项目管理服务质量提供科学依据,为控制血压提供建议。方法于2021年1—12月,采用多阶段分层随机抽样方法在云南省8个县/区抽取≥18周岁常住居民,共对9600人进行问卷调查、体格检查和实验室检测。将≥35岁的1521例既往高血压患者作为研究对象,随后使用身份证号与云南省基本公共卫生服务管理系统进行匹配,把匹配到的既往高血压患者作为管理组,未匹配到的作为非管理组,对比两组的一般特征、血压控制情况、接受服务内容情况及血压控制影响因素。结果共纳入≥35岁的既往高血压患者1521例,其中管理组1011例,非管理组510例。管理组的血压控制率(33.2%)高于非管理组(22.0%)(P<0.05)。管理组中,曾经接受过限盐(89.5%vs.81.7%)、规律运动(86.9%vs.79.2%)、体重控制(84.6%vs.77.4%)、戒烟(83.8%vs.78.7%)、限酒(84.1%vs.78.3%)、心理指导(81.3%vs.72.9%)等生活方式指导服务的比例均高于非管理组的(均P<0.05);接受6项服务内容的管理组血压控制率分别为33.6%、33.5%、34.3%、33.7%、34.0%、33.4%,均高于非管理组的22.8%、22.0%、22.3%、22.4%、22.5%、21.7%(均P<0.05)。多因素logistic回归分析结果显示,文化程度较高者、城市居民、遵医嘱服药者、接受基本公共卫生服务管理者是血压控制保护因素。结论云南省基本公共卫生服务对高血压患者的管理率较高,相较于未管理组,高血压管理能有效提升患者血压控制率。

Objective To investigate the effect of blood pressure control its influencing factors in hypertensive patients under disease management of basic public health services(BPHS)in Yunnan province for improving the patients′blood pressure control and BPHS′community disease management.Methods The participants of the study were 1521 previously diagnosed hypertension patients aged≥35 years identified via questionnaire interview,physical examination,and laboratory tests conducted among 9600 permanent adult residents recruited with multistage stratified random sampling in 8 counties/districts of Yunnan province during 2021.Of the participants,1011(66.5%)were assigned into a management group(under the BPHS′s disease management confirmed by matching the participants′identification card[ID]number with the records in the BPHS′s disease management information system)and 510(33.5%)into a non management group(with the ID numbers not matched with the records of the information system).Demographic characteristics,disease management/blood pressure control(maintaining a systolic/diastolic blood pressure below 140/90 mmHg)and their associates of the participants were analyzed and compared between the two groups.Results The observed blood control rate was significantly higher among the participants of management group than that among those of non management group(33.2%vs.22.0%,P<0.05).Compared to those of the non management group,the participants of management group reported significant higher proportions of having received doctors′lifestyle guidance on decreasing salt intake(89.5%vs.81.7%),regular physical exercise(86.9%vs.79.2%),body weight control(84.6%vs.77.4%),smoking cessation(83.8%vs.78.7%),restricting alcohol consumption(84.1%vs.78.3%),and psychological counseling(81.3%vs.72.9%)(all P<0.05);for all the participants having accepted the six items of lifestyle guidance mentioned above,the observed blood pressure control rates of the management group′s participants were significantly higher than those of the non management group′s participants(33.6%vs.22.8%,33.5%vs.22.0%,34.3%vs.22.3%,33.7%vs.22.4%,34.0%vs.22.5%,and 33.4%vs.21.7%,all P<0.05).The results of multivariate logistic regression analysis showed that the participants with higher education,being urban residents,having medication according to physician′s prescription,and receiving BPHS′s disease management were more likely to have their blood pressure under control.Conclusion In Yunnan province,the community hypertension patients under BPHS′disease management have a better blood pressure control compared to the patients without the management,suggesting a good efficiency of the BPHS′disease management in the province.