社区家庭医生管理高血压患者效果研究

目的 研究分析社区家庭医生制度实施1年后高血压患者管理的效果,探寻社区高血压病患者血压有效控制的医护模式.方法 选取我社区管辖内的146例高血压患者,依据患者自身意愿将其分为干预组（病患与社区卫生服务中心签订家庭医生服务协议并进行家庭医生高血压管理）与对照组（没有意愿与社区卫生服务中心签订家庭医生服务协议,进行传统社区高血压管理）各73例,对比分析两组患者1年后的高血压理论知识、自我管理能力、血压控制水平和治疗依从性结果数据.结果 干预组患者收缩压与舒张压明显低于对照组,血压控制良好.干预组患者对于高血压诊断标准、高血压危害和高血压治疗与预防等知识的知晓率高于对照组.干预组患者心理调整、合理运动、饮食调整、规律用药、监测血压和定期复查等自我管理能力和治疗依从性各项指标高于对照组.两组患者结果数据对比差异有较强显著性,具有统计学意义（P＜0.05）.结论 实施家庭医生管理高血压患者的医护模式能够提高病患理论知识、自我管理能力和治疗依从性,有效控制患者的血压,提升其生活质量.

Study on the Effect of Community Family Physicians Managing Patients with Essential Hypertension

OBJECTIVE Research and analysis system of the management effect of carrying community family doctors for patients with hypertension results after 1 year, explore the effective control of blood pressure in hypertensive patients in community care models. METHOD Selected I Community jurisdiction within of 146 cases hypertension patients, according to disease patients＇ it is divided into intervention group（disease patient and community service center signed family doctor service agreement and for family doctor hypertension management）and control group（for traditional community hypertension management）each 73 cases, compared analysis two group disease patient after 1 years of hypertension theory knowledge, and self management capacity, and blood pressure control level and treatment compliance sex results data. RESULTS Of the intervention group patients with systolic blood pressure and diastolic blood pressure were significantly lower in the control group, good blood pressure control. Diagnostic criteria for intervention group patients for hypertension, high blood pressure harm and the prevention and treatment of hypertension and other knowledge than a control group. Intervention group patients psychological adjustments, proper exercise, diet, regular medication, self-management skills, such as monitoring blood pressure and regular review of compliance indicators higher than the control group. Two sets of patient outcome data differences more significant, statistically significant（P〈0.05）. CONCLUSION Family physicians managing patients with hypertension care models improve patient knowledge, self-management and treatment compliance, effective control of the patient＇s blood pressure, improving their quality of life.