应用《高血压防治基层实用规范》对社区医生的培训效果分析

目的评价应用《高血压防治基层实用规范》对社区医生进行培训的效果，为社区高血压防治提供指导。方法2003年采用前瞻性干预试验研究方法，选取北京市城乡各2个社区卫生服务中心在班医牛分为干预组（包括城市干预组、农村干预组）和对照组（包括城市对照组、农村对照组）。干预组医生接受以该规范为内容的培训，对照组医生不接受该规范及相关培训。分别在培训前和培训1年后采用相同问卷（满分32分）以闭卷考试形式对各组在班医牛进行2次横断面调查，分析医牛对高血压防治相关知识的知晓情况。结果城市干预组培训前后分别为39人和33人，城市埘照组培训前后分别为15人和16人，农村干预组培训前后分别为30人和33人，农村对照组培训前后分别为21人和22人。培训后，干预组医牛对高血压防治知识的总体认知水平得到显著提高，城市干预组医生的得分率从平均45．6％（15／32）提高到81．O％（26／32）（P〈0．01），在扣除了对照绀的变化后，净升高28．5％（9／32）。农村干预组医生的得分率从40．7％（13／32）提高到62．6％（20／32）（P〈0．01），在扣除农村对照组的变化后净升高22．2％（7／32）。干预使城市和农村社区医生高血压防治的6个方面知识均得到了显著提高，其中城乡干预净效果最明显的均体现在医生对血压控制目标（得分率净升高51．7％和31．5％）和药物治疗原则（得分率净升高42．2％和27．6％）的掌握上。结论以《高血压防治基层实用规范》为内容的培训能显著提高城乡社区医生对高血压防治知识的掌握程度。

Effectiveness of guideline-oriented training for community health-care workers with "Applied Standards for Hypertension Prevention and Control at the Grassroots"

Objective To evaluate effectiveness of guideline-oriented training for community healthcare workers (HCWs) with "The Applied Standards for Hypertension Prevention and Control at the Grassroots" to provide guidance to hypertension management in communities. Methods In 2003, four community health-care service centers in Beijing were selected and assigned as intervention (one at urban and one at rural) and control (one at urban and one at rural ) groups, respectively. HCWs in the intervention group received guideline-oriented training based on "The Applied Standards for Hypertension Prevention and Control at the Grassroots", while HCW in the control group did not. All HCWs participated in tests of the knowledge of hypertension management using the same questionnaire before and after the training to analyze their changes in awareness scores with a full of 32. Results There were 39 and 33 HCWs in the intervention group and 15 and 16 HCWs in the control group, respectively at urban, and 30 and 33 HCWs in the intervention group and 21 and 22 HCWs in the control group, respectively at rural before and after the training were involved in the tests, respectively. After training, overall knowledge scores of hypertension prevention and control in HCWs in the intervention group at urban increased obviously, with an average score of 26 of 32 ( 81.0% ) after training from 15 of 32 (45. 6% ) before it ( P ＜ 0. 01 ) , with a net increase of 28.5% (9/32), as compared to HCWs in the control group. Those at rural increased to 6. 6% (20/32) after training from 40. 7% (13/32) before it ( P ＜ 0.01 ), with a net increase of 22. 2 percent (7/32), as compared to HCWs in the control group. Their awareness of knowledge of hypertension prevention and control significantly improved, with the most obviously in the target of blood pressure control (51.7% vs. 31.5% ) and principles of pharmaceutical therapy (42. 2% vs. 27. 6% ). Conclusions Guideline-oriented training based on "The Applied Standards for Hypertension Prevention and Control at the Grassroots" can effectively improve community HCWs' awareness of knowledge of hypertension management and should be widely promoted in communities.