基层医生高血压相关知识和临床诊治能力对就诊高血压患者的影响

Study on the influence of knowledge about hypertension and clinical management competence among physicians treating hypertensives in district and community hospitals

目的 分析北京市基层医院医生高血压相关知识水平和临床诊治能力对就诊高血压患者接受辅助检查、非药物治疗和血压控制的影响。方法 2 0 0 2年 7～ 10月对北京市海淀区和朝阳区9家基层医院内科系统的 181名医生进行高血压相关知识和临床诊治能力的问卷调查 ,同时对这 9家医院的 2 0 4名门诊高血压患者进行拦截式问卷调查。结果 (1)通过对被调查医生的高血压相关知识和临床诊治能力的评价 ,将 9家医院分为高分组和低分组 ,有 4家医院被分为高分组 (包括 2家一级医院、2家二级医院 ) ,5家医院被分为低分组 (包括 3家一级医院、2家二级医院 )。 (2 )一、二级医院医生的高血压相关知识和临床诊治能力的评价结果差异没有显著性 ;在二级医院就诊的高血压患者接受“增加体力活动”、“限盐”、“心理平衡”、“减重”指导的比例明显高于一级医院。 (3)在高分组医院就诊的高血压患者接受眼底检查和动态血压的比例 ,以及接受“增加体力活动”、“限盐”、“减重”指导的比例均明显高于低分组医院 ;高分组医院的高血压患者当天或最近一次血压和近 3个月的血压控制正常的比例均显著高于低分组医院。结论 基层医生的高血压相关知识和临床诊治能力对就诊高血压患者有重要影响 ,应加强对基层医生的相关培训。

Objective To analyze the influence of knowledge about hypertension and clinical competence among physicians in district and community hospitals on management of hypertensives. Methods Questionnaire investigation was used in 9 district and community hospitals in Chaoyang and Haidian district, including 181 physicians and 204 patients with hypertension. Results (1) The hospitals involved were divided into two groups according to our evaluation on the knowledge of hypertension and clinical competence of physicians. Four hospitals were graded as high-score group and 5 hospitals as low-score group. (2) There was no significant difference on physicians'evaluation between district and community hospitals. There was higher proportion of hypertensives with instructed physical exercises,reducing salt ingestion,psycological balance and weight reduction in district hospitals than those in community ones.(3) The proportion of hypertensives who were examined with funduscopy,ambulatory pressure and instructed with physical exercises,reducing salt ingestion and weight reduction in high-score group was obviously higher than that in low-score group. The control rates of blood pressure, on the days of examination during lastest check-up or the past three months, were significantly higher in high-score group than in low-score group ( P < 0.05 ). Conclusion Knowledge of hypertension and clinical management competence among physicians in district and community hospitals did influence the management of hypertension and education of physicians and thus should be increased.