“医患双达标”模式在中重度高血压患者管理中的效果评估

Effects of “target for both doctors and patients” model in patients' management with essential hypertension

目的探讨"医患双达标"医疗模式在中重度高血压管理中的应用效果。方法招募2014年9月至2015年9月在山西省人民医院门诊中重度高血压患者300例,按就诊时间的单双号分为试验组和对照组,每组150例,均由临床医师制订适合患者的个体化治疗方案,并于4、12、24周到门诊随访;其中临床医师使用"健康达标手册"对试验组患者进行教育,告知血压及相关危险因素的管理达标值,同时高血压管理专员对患者进行电话随访和教育。临床医师仅给予对照组患者口头的高血压健康教育。结果 283例患者完成全部研究,其中试验组患者146例,对照组患者137例;两组患者平均收缩压和平均舒张压在管理24周后差异有统计学意义(P<0.05),试验组患者平均血压下降19.66 mm Hg/12.20 mm Hg;试验组患者在管理24周后与自身基线及对照组相比,总胆固醇、低密度脂蛋白胆固醇、尿酸、同型半胱氨酸均值明显下降,高密度脂蛋白胆固醇明显上升,差异有统计学意义(P<0.05);试验组吸烟减少人数占吸烟人数的68.0%、饮酒量减少人数占饮酒人数的64.90%,每周运动>3次且每次>30 min的比例增加至50.68%,食用盐量减少的比例增加70.54%,与对照组相比差异有统计学意义(P<0.05)。结论 "医患双达标"模式可以进一步降低中重度高血压患者血压水平,提高血压控制率,降低心血管危险因素,改善患者不良的生活方式和依从性。

Objective To investigate the application effects of 'target for both doctors and patients' medical model on moderate or severe hypertension management. Methods Totally, 300 patients with moderate or severe hypertension had been treated in out-patient department in Shanxi Province People's Hospital from September 2014 to September 2015. Patients were assigned to two management groups by the admission date(odd and even number). In two groups, doctors formulated individual plans for patients follow-up visit or adjusted drug therapy in time; Patients followed in outpatient department after 4 weeks, 12 weeks, 24 weeks. In test group, doctors used the health target manual to educate patients including target value of blood pressure and relevant risks; Hypertension managers followed and educated by telephone to patients. In control group, doctors only educated patients by oral communication. Results 283 patients completed the test, including test group(n=146) and control group(n=137). The difference of mean blood pressure was significant(P<0.05) after 24 weeks management, mean systolic and diastolic pressure in test group fell 19.66 mm Hg/12.20 mm Hg after 24 weeks. At 24 weeks, test group patients' levels of average total cholesterol, low density lipoprotein cholesterol, uric acid, homocysteine were lower and average high density lipoprotein cholesterol were higher than itself baseline and control group(P<0.05). The rates of hypertension patients with smoking and drinking in test group reduced by 68.0% and 64.90% respectively, meanwhile the rate of physical exercise>3 times/week as well as every time>30 min and salt intake reduction significantly increased by 50.86% and 70.54% in test group after 24 weeks which was significantly higher than control group(P<0.05). Conclusions 'Target for both doctors and patients' medical model can not only lower the blood pressure level of moderate or severe hypertension patients, improve blood pressure control rate and reduce cardiovascular hazards, but also change unhealthy life and compliance.