社区高血压糖尿病自我管理对患者相关行为影响的研究

目的 在社区慢性病管理研究中引入患者自我管理模式并观察自我管理对患者相关行为的影响。方法对274名高血压患者和94名糖尿病患者发放自我管理手册，通过讲座等形式培训自我管理技能，并指导患者填写自我管理手册，对照目标行为进行自我管理，由责任医生根据目标行为达标天数和记录情况判定自我管理水平。结果自我管理的患者中定期测量血压（血糖），家庭测量血压（血糖），规律运动，控制饮食、控制脂肪和钠盐摄入和规范服药的比例有不同程度地提高，其中家庭测量血压和血糖的患者比例分别提高了37．6％和52．5％；定期监测血压血糖的比例也分别提高了10．0％和28．9％。结论在社区卫生人员指导下设立健康行为目标，进行自我管理并进行监测和评估，对控制高血压和糖尿病的相关正确行为的形成是有效的。

The influence of self-management on health care behavior among patients with hypertension or diabetes mellitus in Haishu district, Ningbo City

Objective To introduce the self-management into community chronic non- communicable disease management and observe the effect of relevant health care behavior among patients with hypertension or diabetes mellitus. Methods To provide the self-management manuals to patients with hypertension (n=274) or diabetes mellitus (n=94) who were volunteer to participant, give them training on self-management skills, and ask them fill out the manual and carry their self- management. The doctors from health service center determinated the grade of self-management according to the days the patients' behavior reached the demand and the quality of the note of manual. Results The percentage of the patients who took the measurement on blood pressure and blood sugar regularly was increased by 10.0% and 28.9%, and the percentage of taking the measurement at home by themselves increased 37.6% and 52.5%. And correct percentage of other health care behavior such as more physical activities, less fat and salt intake, and taking the medicine reasonable increased as well. Conclusion It is effective to adopt health behavior for patients with hypertension and diabetes mellitus by the ways of self-management.