上海社区高血压疾病细节管理对高血压患者知识知晓率的影响研究

目的通过多中心的社区干预试验,评价社区高血压疾病细节管理对高血压患者相关知识知晓度的影响。方法在上海市4个中心城区的社区卫生服务中心中共招募1 442例高血压患者,分为细节管理组961例、日常管理组481例。细节管理组:设立社区健康管理专员专岗,增进社区医生与患者的沟通,提高患者服药依从性,对患者进行生活方式指导,并为社区医生定期收集血压等相关信息并反馈;开发和应用社区管理信息平台和患者管理工具。日常管理组:采用常规的管理模式。结果细节管理组和日常管理组对高血压相关的各项知识知晓情况均较基线有所提高。干预后细节管理组的收缩压和舒张压均低于日常管理组,血压达标值、高血压患病危险因素、高血压防治原则等知晓度评分,细节管理组显著优于日常管理组,差异有统计学意义(P<0.05)。细节管理组收缩压与知晓度评分总分的相关系数为-0.352(P=0.000),舒张压与知晓度评分总分的相关系数为-0.262(P=0.000)。结论上海社区高血压疾病细节管理是提高高血压患者相关知识知晓度和血压控制水平的有效措施。

Influence of Disease Details Management Program for Hypertension on Awareness of Hypertension Related Knowledge of Patients with Hypertension in Shanghai Community

Objective To evaluate the effect of disease details management program for hypertension in community on awareness of hypertension related knowledge through community based multi-center trial of intervention. Methods Totally 1 442 patients from 4 communities in urban Shanghai were enrolled and divided as intervention group(n=961) and usual group(n=481).The intervention programs for the intervention group included disease management by special care managers who enhance communication between physicians and pat...