医护组合模式对社区高血压疾病管理的实践探索

目的探讨医护组合模式对社区高血压疾病管理的效果，为家庭医生制度在社区更好地推行提供经验。方法在家庭医生制度下，在上海新华街道社区卫生服务中心管辖的陈家巷居委会常住居民中的高血压患者间推行医护组合模式，与模式推行前高血压患者的血压情况进行比较分析。结果推行3个月后，患者血压得到有效控制；推行6个月后，患者血压和病情的控制和管理更为显著。结论在社区推行医护组合模式能够更好地发挥家庭医生“健康守门人”的作用，更加合理地配置已有的医疗资源，更有效地促进居民健康，同时有助提高社区居民的满意度和信任度。

Practice and exploration of doctor-nurse associated model in community hypertension management

Objective To discuss effect of doctor-nurse-associated model in community hypertension management, and to provide experiences of implementation of family physician system in Shanghai. Methods Patients with hypertension in Chenjiaxiang Neighborhood Committee were selected to receive doctor-nurse associated model management of family physician system. The blood pressure values were measured and analyzed. Results The blood pressure was controlled effectively 3 months after practice of doctor-nurse associated model management, and there was significant improvement 6 months later. Conclusion Implementation of doctor-nurse associated model reveals the role of ＂goalkeeper of health＂ of family physicians, which would configure medical resources more rationally, improve health conditions of residents, and raise residents＇ satisfaction and trust.