契约式管理模式对社区高血压患者综合干预效果评估

目的探讨“契约式”管理模式对社区高血压患者综合干预效果，为今后在社区中开展高血压防治管理工作提供指导。方法在社区红光、葑村、丰明、丰收及三星、五星村居委中，按照整群分层抽样方法共抽取540名高血压患者。然后，依据契约式服务合同管理情况，随机将患者平均分为两组，列为干预组及对照组进行定期随访，为期观察三年。结果经过干预以后两组相比，高血压患者服药依从性前者高于后者28．6％（P〈0．01）。干预组患者高血压知识知晓率比对照组高33．6％。高血压患者为控制血压而采取行为改变的比率，包括限盐、运动、减肥、控烟、控酒，分别高于对照组15．2％、10．1％、12．2％、7．8％、3．2％，限盐、运动、减肥这3项在干预前后差异有统计学意义（P〈0．01）。此外，平均收缩压和平均舒张压控制水平干预前后分别下降5mmHg、3mmHg，差异有统计学意义（P〈0．05）。签约患者对卫生服务满意率，前者高于后者15．3％，有统计差异。结论“契约式服务管理”模式有利于提高患者高血压防治知识的知晓率、对卫生服务的满意率及对高血压综合防治工作的依从性，它对于提高社区高血压控制率是一种有益的尝试。

Effectiveness Assessment of Contractual Management to the Comprehensive Intervention of the Community Hypertensive Patients

Objective To explore the effectiveness assessment of the contractual management to the comprehensive intervention of the community hypertensive patients to provide the guidance for carrying out the management of hypertension prevention and control in the community for the future. Method A total of 540 patients with hypertension were recruited among the Hong Guang, Feng Cun, Feng Ming, Feng Shou and San Xing, Wu Xing communities by stratified cluster sampling method. Then, patients were divided into two groups at random according to ＂the contractual management model＂, as the intervention group and control group, and the follow-up observation period is three years. Results The two groups were compared. The former group was higher than the latter 28.6 % （P〈0.01） in the compliance of taking medicine among hypertension patient. The intervention group was higher than the control group by 33.6% in the knowledge about high blood pressure. The ratio of the change in behaviors, including salt restriction, exercise, weight loss, tobacco and wine control and etc. In the former was higher than those in the latter by 15.2%, 10.1%, 12.2%, 7.8%, 3.2%（P〈0.01）. There were no obvious differences in the aspects of controlling of alcohol and smoking. In addition, the result of the comparison of the controlling of the average systolic and diastolic blood pressure before and after intervention was the former lower than the latter by 5mmHg.3mmHg which had statistical difference （P〈0.05）. There is a statistical difference between the satisfaction rates of health services in the patients who signed contract, the former is higher than the latter by 13.8%. Conclusion It is favorable that the ＂contractual service management＂ model will help to improve the rate of the awareness of prevention and treatment of patients with hypertension, and the rate of satisfac tion of health services and the compliance of comprehensive intervention of hypertension. It is a useful attempt for improving the control rate of hypertension in communities.