海口市社区老年人健康管理效果评估

目的 评估海口市社区60岁及以上老年人群分类健康管理效果,为制定老年人健康管理策略和措施提供依据.方法 采用社区干预试验方法,于2015年6月至2016年7月选取海口市美兰区大致坡、三江两社区各1000名自愿参与的60岁及以上老年人作为干预组和对照组,在开展基线调查后对干预组进行分类管理,对照组不做干预.比较两组人群12个月前后健康知信行、健康状况相关指标与卫生利用23个测量指标变化值和高血压或糖尿病发生率.结果 干预组除口味偏咸和过去6个月上门诊次数外,健康知识整体知晓率、定期监测血压、定期监测血糖、吸烟、每天吃蔬菜水果、充足睡眠、经常参加锻炼、感到压力大、感到担心害怕、月平均医疗费用、就医首选社区医院、小病首选社区医院、血压、空腹血糖14个变量得到显著的改善,差异有统计学意义(P均<0.05),遵医嘱服用降压药、遵医嘱服用降糖药、饮酒、饮用豆浆牛奶、BMI和过去6个月住院次数和天数7个指标差异无统计学意义(P>0.05);对照组吸烟、饮酒、充足睡眠、血压、血糖5个指标差异无统计学意义(P>0.05),遵医嘱服用降压药、遵医嘱服用降糖药、定期监测血压、就医首选社区医院、小病首选社区医院5个指标第二次问卷情况优于第一次,其他13个指标第一次问卷情况优于第二次,差异均有统计学意义(P<0.05).干预组高血压或糖尿病发生率为3.4%,对照组为10.9%,差异具有统计学意义(P<0.001).结论 对社区老年人群实施分类健康干预管理,可有效降低高血压、糖尿病等慢性病发病风险,控制医疗保险费用支出.应制订相应管理办法加强非患病老年人健康管理.

Evaluation on the effect of health management on the elderly in communities in Haikou City

Objective To evaluate the effect of classified health management program on the elderly aged 60 years and over in the communities of Haikou, and to provide the evidence for establishing health management strategies and measures for the elderly. Methods With community-based prospective cohort study, from June 2015 to July 2016, a total of 1000 elderly volunteer participants aged 60 years and over, who came from Sanjiang Community and Dazhipo Community in Meilan District, Haikou, were selected and divided into the the management group and the control group. After grouping and baseline survey, the management group received the intervention, while the control group was not in-terfered. All subjects were required to complete questionnaires at baseline and 12-months later. The questionnaires in-clude the basic information of the elderly, the knowledge attitudes and practices (KAP) of health, the change of 23 health status and health service utilization related outcome variables, and the incidence of hypertension or diabetes, and the in-formation of the questionnaires of the two groups were compared. Results Non-parametric test were used to compare the change of 23 outcome variables, and the results showed that, with the exception of partial salty taste and clinic visits during past 6 months, the management group demonstrated significant improvement in 14 variables (health knowledge overall awareness, regular monitoring of blood pressure, regular monitoring of blood glucose, smoking, vegetable and fruit consumption, adequate sleep, physical activity, feeling the pressure, feeling fear, average monthly medical expense, medical treatment preferred community hospital, ailment preferred hospital, blood pressure, fasting blood glucose, all P<0.05. There were no significant changes in the number hospitalization and days in the past six months, body mass index (BMI), medication compliance of taking the antihypertensive drugs and taking the hypoglycemic agents, alcohol, soybean milk or milk consumption (all P>0.05). There were no significant changes in smoking, alcohol, adequate sleep, blood pressure, blood glucose in the control group. The second questionnaire was better than the first time in the control group in the medication compliance of taking the antihypertensive drugs, taking the hypoglycemic agents, regular monitoring of blood glucose, medical treatment preferred community hospital, ailment preferred hospital, and the first questionnaire was better than the second time in the others variables (P<0.05). The incidence of hypertension or diabetes in the manage-ment group was 3.4%, which was significantly lower than 10.9%in control group (P<0.001). Conclusion The imple-mentation of classified health intervention for the elderly in the community can effectively improve the health KAP and reduce the risk of chronic diseases, such as hypertension, diabetes, which will also play a very important role in con-trolling medical insurance costs. So, to develop appropriate management measures to strengthen health management of healthy elderly is necessary.