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目的探讨契约式管理对社区高血压患者血压控制情况、提高患者自我效能和自我管理的情况是否优于目前的三级管理模式,是否可有效降低并发症的发生。方法应用流行病学实验研究方法。实验组采用高血压契约式管理模式,根据自愿原则共签订健康保健协议214人;对照组采用高血压三级管理模式,按照性别、年龄、血压水平匹配原则选定214人,从2014年10月开始各干预1年,观察干预后效果。采用SPSS 17.0软件对数据结果进行统计分析。结果干预后,实验组血压下降14.03/6.12 mmHg;对照组血压下降了7.32/3.07mmHg,差值均有统计学意义。实验组中危以上高血压患者减少了37.4%;低危高血压患者减少了12.4%;对照组分别减少了20.6%和6.7%,两组率差均有显著性差异(P值均<0.01)。实验组服药依从性的评分提高了0.9,在医生指导下管理高血压的信心计分降低了0.48,克服高血压带来负面影响的信心计分降低了0.57;对照组分别提高0.43,降低了0.15和0.16。两组差值有显著性差异(P值均<0.01)。实验组规律测压率、医患交流率分别提高了43.1%和43.6%。对照组分别提高了15.8%,1.4%,两组率差有统计学意义。实验组有1人发生了并发症,对照组有7人发生了并发症,经卡方检验,P<0.05,差别有统计学意义。结论契约式管理的血压控制效果、提高患者自我效能和自我管理能力均优于对照组,有效降低了并发症的发生率。
Objective To investigate whether the contractual management of blood pressure control in community patients with hypertension, improve patient self-efficacy and self-management is better than the current three-level management, whether it can effectively reduce the incidence of complications. Methods Apply epidemiological experimental research methods. In the experimental group, 214 people were signed a health care agreement according to the voluntary principle. The control group adopted the three-level management model of hypertension and 214 people were selected according to the gender, age and blood pressure level matching principle. From October 2014 Each intervention began 1 year, observe the effect after intervention. SPSS 17.0 software was used to analyze the data. Results After the intervention, the blood pressure of the experimental group decreased by 14.03 / 6.12 mmHg; the blood pressure of the control group decreased by 7.32 / 3.07 mmHg, the differences were statistically significant. In the experimental group, 37.4% of the patients with at-risk hypertension were reduced; 12.4% of those with low-risk hypertension were reduced; 20.6% and 6.7% of those in the control group were decreased respectively, with significant difference between the two groups (P <0.01) . The medication adherence score increased by 0.9 in the experimental group, the confidence score for managing hypertension was reduced by 0.48 under the guidance of a doctor, and the confidence score for overcoming the negative effect of hypertension was decreased by 0.57; the control group increased by 0.43 and decreased by 0.15 And 0.16. There was significant difference between the two groups (P <0.01). The experimental group’s rate of pressure measurement and exchange rate between doctors and patients increased by 43.1% and 43.6% respectively. Control group were increased by 15.8%, 1.4%, the difference between the two groups was statistically significant. One patient in the experimental group had complications, and 7 patients in the control group had complications. The chi-square test showed that there was a significant difference (P <0.05). Conclusion The contract-based management of blood pressure control effect, improve patient self-efficacy and self-management ability are better than the control group, effectively reducing the incidence of complications.