HDSMP结合CDSMP模式对老年高血压患者疾病应对和自我管理能力的影响

Effects of HDSMP combined with CDSMP model on disease coping and self-management abilities in elderly hypertensive patients

目的 探讨本土化的高血压、糖尿病自我管理教程(hypertension&diabetes self-management program, HDSMP)结合美国斯坦福大学首创的普适性慢性病自我管理项目(chronic disease self-management program, CDSMP)对老年高血压患者疾病应对和自我管理能力的影响。方法 选取2021年6-12月在郑州大学第一附属医院内科门诊就诊的符合纳入和排除标准的300例老年高血压患者作为研究对象,采用随机数字表法分为对照组150例和干预组150例。对照组患者接受以健康讲座和宣教手册为主的健康教育,干预组患者接受HDSMP结合CDSMP模式的慢性病自我管理,以自我管理小组的形式进行。两组患者的干预时间均为8周。评价并比较两组患者干预前后的疾病认知情况、生活质量、疾病应对能力、自我管理能力、血压控制效果。结果 干预组干预后对高血压知识(包括疾病诊断标准、高危因素、高血压危害、治疗方法)知晓率相比较干预前和对照组干预后均明显升高,差异有统计学意义(P<0.05)。干预组干预后健康调查简表(SF-36)各维度评分相比较干预前和对照组干预后均明显升高,差异有统计学意义(P<0.05)。干预组干预后医学应对方式问卷(medical coping modes questionnaire, MCMQ)中的面对得分相比较对照组干预后明显升高[(22.70±2.28)分vs.(20.95±2.62)分],屈服、回避得分相比较对照组干预后明显降低[(5.13±1.36)分vs.(5.96±1.65)分,(13.72±1.45)分vs.(15.10±1.49)分],差异有统计学意义(P<0.05)。干预组干预后自我管理各维度评分和总评分均显著高于对照组干预后(P<0.05)。两组患者干预后的舒张压和收缩压相比较干预前均显著降低,其中干预组相比较对照组降低更明显(P<0.05),干预后干预组的血压控制达标率相比较对照组明显升高(收缩压:88.67%vs. 76.00%,舒张压:93.33%vs. 78.67%,P<0.05)。结论 HDSMP结合CDSMP模式对提高和改善老年高血压患者的疾病应对能力、自我效能和自我管理能力的效果更佳,从而能进一步提高和改善患者的血压控制达标率及生活质量水平。

Objective To investigate the impact of a localized hypertension and diabetes self-management pro-gram(HDSMP)combined with the Chronic Disease Self-Management Program(CDSMP)developed by Stanford Univer-sity on disease coping and self-management abilities in elderly hypertensive patients.MethodsA total of 300 elderly hypertensive patients who met the inclusion and exclusion criteria and attended the internal medicine outpatient clinic at the First Affiliated Hospital of Zhengzhou University from June to December 2021 were randomly divided into intervention group(n=150)and control group(n=150)using a random number table.Patients in the control group received health education primarily through health lectures and educational booklets,while patients in the intervention group received chronic disease self-management using the HDSMP combined with the CDSMP model in the form of self-management groups.The intervention period for both groups was 8 weeks.Disease awareness,quality of life,disease coping abilities,self-management abilities,and blood pressure control outcomes were evaluated and compared before and after the intervention in both groups.Results After the intervention,the awareness of hypertension knowledge(including disease diagnostic criteria,high-risk factors,hypertension hazards,and treatment methods)in the intervention group significantly increased compared to before the intervention and the control group after the intervention,and the differences were statistically significant(P<0.05).The scores on all dimensions of the Short Form-36(SF-36)health survey in the intervention group significantly increased compared to before the intervention and the control group after the intervention,and the differences were statistically significant(P<0.05).In the medical coping modes questionnaire(MCMQ),the intervention group had a significantly higher confrontational coping score(22.70±2.28 us.20.95±2.62),and significantly lower yielding and avoidance scores(5.13±1.36 vs.5.96±1.65,13.72±1.45 vs.15.10±1.49)compared to the control group after the intervention,and the differences were statistically significant(P<0.05).The intervention group had significantly higher scores in all dimensions of self-management and the total score compared to the control group after the intervention(P<0.05).Both groups showed a significant decrease in diastolic and systolic blood pressure after the intervention compared to before the intervention,with the intervention group showing a greater reduction in systolic pressure and diastolic pressure.The achievement rate of blood pressure control in the intervention group significantly increased after the intervention compared to the control group(systolic pressure:88.67%vs.76.00%,diastolic pressure:93.33%vs.78.67%,P<0.05).Conclusion The combination of HDSMP and CDSMP has a better effect on improving disease coping abilities,self-efficacy,and self-management abilities in elderly hypertensive patients,thereby further increasing and improving the rate of achieving blood pressure control standards and the quality of life.