广州市社区老年高血压患者自我管理现状及干预效果分析

目的分析广州市社区老年高血压患者自我管理现状及干预效果,为改善社区卫生服务提供依据。方法采用整群抽样的方法,抽取60~75岁确诊为高血压且建立健康档案的486例患者为目标人群,采用一般情况问卷,高血压患者自我管理、自我效能量、社会支持和慢性病资源问卷进行调查,运用SPSS 18.0统计软件分析自我管理的影响因素;按照单纯随机分组方法将研究对象随机分为对照组和观察组,每组各组243例。对照组采取常规医疗干预,由医务人员随机进行;观察组进行综合干预(常规医疗+自我管理),由自我管理卫生服务团队主持,干预时间为18个月。结果 486例患者有68.1%处于低等自我管理水平,其中管理水平较低的是用药管理(68.1%)、饮食管理(58.8%)和情绪管理(46.3%);自我效能方面,年龄、文化程度、丧偶独居和慢性病管理是自我管理总分的主要影响因素;综合干预后,观察组自我效能和自我管理得到显著改善(P<0.05),血压控制优良率显著高于对照组(P<0.05),而血压控制不良率显著低于对照组(P<0.05)。结论自我效能、社会支持、慢性病管理、文化程度与自我管理总分关系密切,综合干预能够显著改善患者自我管理、自我效能和血压控制水平,值得借鉴和推广。

Analysis of Self-management Status and Intervention Effect of Elderly Patients with Hypertension in Guangzhou Community

OBJECTIVE To analyze the self-management status and intervention effect of elderly patients with hypertension in Guangzhou community, so as to provide basis for improving community health services. METHODS A total of 486 patients aged 60~75 years who were diagnosed with hypertension and established health records were selected as the target population by cluster sampling. The general situation questionnaire, self-management, self-efficacy energy, social support and chronic disease resource questionnaire were used to investigate.The influencing factors of self-management were analyzed by SPSS 18.0 Statistical Software. The subjects were randomly divided into control group and observation group, 243 cases in each group. The control group received routine medical intervention, which was randomly conducted by medical staff;the observation group received comprehensive intervention(routine medical treatment + self-management), which was presided over by the self-management health service team, and the intervention time was 18 months. RESULTS 68.1% of the 486 patients were in low level of self-management, the lower of which were medication management(68.1%), diet management(58.8%) and emotion management(46.3%);in terms of self-efficacy, age, education level, widowhood, solitude and chronic disease management were the main factors affecting the total score of self-management;after comprehensive intervention, the self-efficacy and self-management of the observation group were significantly improved The excellent rate of blood pressure control was significantly higher than that of the control group(P<0.05), while the poor rate of blood pressure control was significantly lower than that of the control group(P<0.05). CONCLUSION Self-efficacy, social support, chronic disease management and education level were closely related to the total score of self-management. Comprehensive intervention could significantly improve patients’ selfmanagement, self-efficacy and blood pressure control level, which was worth learning and promoting.