东海县农村老年人高血压社区规范化管理效果评价

目的评价东海县农村老年高血压患者的社区规范化管理效果,探讨农村老年高血压防治模式。方法 2009年对东海县农村的老年高血压患者落实由经过培训的社区医生进行规范化管理(健康教育、行为干预、药物治疗和定期随访等),2年后评价其效果。结果参加社区高血压规范化的老年高血压患者4 149例,其中男性1 862例,女性2 287例,规范化管理后平均收缩压和舒张压分别降低了16.56和8.97 mmHg,知晓率、治疗率、血压控制率由管理前的22.99%,15.77%,2.55%分别上升至82.31%,99.40%,38.73%,差别均有统计学意义(P<0.05)。结论针对农村老年人的特点,社区规范化管理能有效改变老年高血压患者不良生活方式,提高药物依从性,良好控制血压,提高生命质量,是防治农村老人高血压的一种行之有效的方法。

Evaluation on effects of standardized community management for elderly hypertensive patients in rural areas of Donghai County

Objective To evaluate the effect of standardized community management for elderly hypertensive patients in rural areas,Donghai County,and explore the model for the prevention and control of the hypertension in elderly people in rural areas. Methods The health education,behavioral intervention,drug therapy,regular follow-up and so on were used to manage the elderly hypertensive patients who were investigated and diagnosed in 2009.The community doctors trained by experts and got certification managed the patients.The effects of standardized community management were assessment after 2 years.Results There were 4 149 elderly hypertensive patients participated in the standardized community management(male 1 862,female 2 287).Compared with the original data,the average systolic blood pressure and diastolic blood pressure were decreased by 16.56 and 8.97 mmHg respectively after 2 years.The rates of awareness,treatment,and blood pressure control about hypertension increased from 22.99%,15.77%,2.55% to 82.31%,99.40%,38.73% respectively(P<0.05). Conclusions According to the characteristics of elderly people in rural areas,community-standardized management can change unhealthy lifestyle effectively of elderly hypertensive patients,increase the rates of compliance of drug therapy and the control rates of blood pressure,and so improve their quality of life.