北京不同级别医院门诊高血压患者治疗状况分析

目的　分析北京市不同级别医院高血压门诊治疗状况。方法　对在北京市 4个三级医院、4个二级医院、31个一级医院门诊就诊的 2379例高血压患者进行随机问卷调查,每个医院 61例。结果　门诊高血压患者的总体高血压控制率为 32 3%,一级、二级、三级医院高血压控制率分别是 31 2%、36 9%、37 7%。三个级别医院高血压控制率差异无统计学意义 (P=0 057)。三级医院长效钙离子拮抗剂、血管紧张素转换酶抑制剂、β受体阻滞剂的应用频率远远高于一、二级医院,而一、二级医院复方制剂和短效钙离子拮抗剂应用频率较高;三级医院高血压患者超声心动图、CT、动态心电图和动态血压检测率明显高于基层医院;三级医院高血压治疗年均费用最高,为 1567 5元,二级医院 845 4元,一级医院 651 8元 (P=0 000 )。结论　被调查的门诊治疗的高血压控制率 ( <140 /90mmHg, 1mmHg=0 133kPa)为 32 3%,仍有 67 7%的患者高血压没有得到控制 (≥140 /90mmHg)。三级医院高血压患者的诊治费用远远高于一级和二级医院,但三个级别医院在血压控制率方面差别无统计学意义。各级医院应努力提高高血压控制率,使已经就诊的患者高血压得到控制。如何指导或安排高血压患者到相应的医院就诊,对合理利用卫生资源具有重要作用。

Analysis of outpatient hypertension treatment among different grade hospitals in Beijing

OBJECTIVE: To analyze the therapy of hypertensive outpatients among different grade hospitals in Beijing. METHODS: Thirty-nine hospitals including 4 third grade hospitals, 4 second grade hospitals and 31 first grade hospitals in Beijing were selected randomly (by stratified randomization). The grade was accredited according to the hospital accreditation standard issued by Ministry of Health of the People's Republic of China. RESULTS: The average hypertension control rate (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in outpatients was 32.3%. The hypertension control rate in the third grade, second grade, first grade hospitals were 37.7%, 36.9%, and 31.2% respectively. There was no difference in the control rate among the three different grade hospitals (P > 0.05). The frequency to use anti-hypertension drugs including long-acting calcium antagonism, ACEI, beta-receptor blocker in the third grade hospitals was significantly higher than those of the first and second grade hospitals. The rate of examination using ultrasonic cardiogram, CT, Holter and ambulatory blood pressure monitoring were significantly higher in the third grade hospitals than that of the first and second grade hospitals. There were significant differences in annual cost of hypertension treatment among three different grade hospitals (P < 0.01), being the highest (1567.5 yuan) in the third grade hospitals, medium (845.4 yuan) in the second grade hospitals, the lowest (651.8 yuan) in the first grade hospitals. CONCLUSIONS: Significant difference in the cost of hypertensive treatment among three different grade hospitals exists in Beijing. However, there was no difference in the control rate among them. The overall hypertension control rate is 32.3%, leaving 67.7% uncontrolled. Efforts to increase the hypertension control rate should be made in all hospitals. How to guide and arrange the hypertension patients to consult a suitable hospital is important for rational and economical use of health cost.