社区综合管理对高血压患者的干预效果分析

目的探讨和评价社区综合管理在高血压防治工作中的作用。方法对2009年1月至2009年6月在本卫生服务中心管辖区域内的原发性高血压患者400例中的180例实施社区综合管理（管理组）,对其余220例进行门诊随访（对照组）。对管理组患者实施健康宣教、自我管理、定期随访、规范药物治疗等高血压综合管理措施。对照组患者仅行规范药物治疗及门诊随访。比较两组患者半年后的防治效果。结果管理组血压控制达标率、对高血压病的认知度、用药依从性高于对照组;管理组的生活方式（体育锻炼、主动测量血压、知晓低盐饮食、知晓戒烟、遵医行为）亦优于对照组。结论规范化的社区综合管理能有效提高高血压患者的自我保健意识,并建立健康行为与生活习惯,从而有效控制血压。

Effectiveness analysis on the comprehensive management in community for hypertension patients

Objective To discuss and evaluate the effect of comprehensive management in community for hypertension control.Method 400 hypertension patients were selected from our Community Health Service during January to June in 2009,the ones were divided into two groups,including 180 hypertension patients collected from the comprehensive management of hypertension in community（management group）and the other 220 from our out-patient department（contrast group）.The management group was treated with health education,self management,regular follow-up and standardize the drug treatment.The contrast group was treated with out-patient follow-up and the standardize drug treatment only.The intervention effect was analyzed between the two groups after 6 months.Results The rate of reaching standard of blood pressure,the cognition degree of hypertension and medication compliance in management group were higher than in contrast group,management group was more inclined to develop good lifestyle（including exercise,active measurement of blood pressure,knowledge of low-salt diet,knowledge of smoking cessation and health compliance behavior）than contrast group.Conclusions The standardized comprehend management in community for hypertension control can improve the self-health awareness in hypertension patients,develop healthy behavior and lifestyle effective,and control effectively blood pressure.