网络信息化管理对提高基层医师高血压诊治水平及社区高血压防治效果评价

目的评价网络信息化管理对提高基层医师高血压诊治能力以及社区高血压防治效果的作用。方法以《中国高血压防治指南》为依据制定了《高血压社区综合干预信息化管理规范》(简称《规范》),根据此方案建立信息化管理网络。于2007—2010年,对干预组医务人员进行网络跟踪临床指导,对干预组≥35岁居民实施全人群分类及高血压分级管理、综合干预,评价其干预效果。结果干预组运用专家网络跟踪指导模式培训社区医师,3年后高血压知识和病例诊治能力均明显提高,平均总分由47.3提高到78.1(P<0.05);干预组实施高血压社区信息化管理后效果显著(P<0.05):全人群管理率由36.0%提高至63.1%;人群收缩压(SBP)、舒张压(DBP)分别下降5.5 mmHg和1.7 mmHg;一、二、三级高血压管理级别比例变化明显,一级管理的比例由干预前67.2%提高至93.8%,二级、三级管理的比例由干预前19.8%、11.8%下降到5.3%、1.9%;高血压知晓率、治疗率和控制率分别由58.7%、48.5%、33.4%提高到89.7%、77.0%和72.6%;不良生活方式及行为有所改善,人群吸烟率、饮酒率、饮食偏咸以及少运动比例由19.7%、24.3%、23.5%、74.2%下降至14.5%、17.5%、15.5%、34.1%;心脑血管病急性事件发病、死亡率呈下降趋势。与对照组比较有统计学意义(P<0.05)。结论网络信息化管理能有效提高社区医师的诊治能力和社区高血压防治效果。

Effects of information management network on prevention,diagnosis and treatment of hypertension in community physicians

Objective To investigate the effects of information management network on prevention, diagnosis and treatment of hypertension in community physicians. Methods Based on China guideline in prevention and treatment of hypertension, the information management criteria for comprehensive intervention of hypertension in community were made and information management network was set up according to the predefined criteria. Physicians in randomized selected communities （intervention group） received training on hypertension management and communicated with cardiovascular specialist through the information management network. Matched communities were selected as control group and received conventional intervention. Data of community population hypertension management and the rates of awareness, treatment and control of hypertension were collected before and 3 years after the intervention. Results The population management rate in intervention group was increased from 35.98% to 66. 18%. And average population systolic blood pressure （SBP） and diastolic blood pressure （DBP） were decreased by 2. 2 mm Hg and 1.7 mm Hg respectively after intervention. The rates of awareness, treatment and control of hypertension in intervention group were increased from 58. 7% to 89. 7%, from 48.5% to 77.0% , and from 33.4% to 72. 6% respectively, and the changes were significantly greater than in control group. Compared with control group, there was a lower trend in the incidence and mortality rate of cardiovascular disease in intervention group. Conclusions Information management prevention, diagnosis and treatment of hypertension.