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目的通过建立定诊医生模式,研究和评价该模式在社区高血压管理方面的应用效果。方法于2010年10月至2011年1月随机选择7个镇所辖范围各2个社区,共14个社区的符合《中国高血压防治指南(2005修订版)》诊断标准的高血压患者作为研究对象,并将研究对象随机分为干预组(762例)和对照组(676例)进行社区干预研究。在实施规范化管理的基础上,干预组建立社区卫生服务中心定诊医生管理模式,对心血管风险水平为高危及以上的重点人群实施强化管理。比较血压变化、危险因素控制、因病死亡、急性事件等情况。应用SPSS 20.0软件进行t检验、χ2检验。结果经过5年管理,干预组平均SBP和平均DBP分别下降12.41和6.71 mm Hg,对照组分别下降9.85和6.34 mm Hg,差异均有统计学意义(P<0.05);与对照组比较,干预组SBP均低于对照组,强化管理的优势更明显;干预组减重、戒烟、戒酒的比例分别为18.40%、20.81%和22.14%,与对照组(分别为7.14%、10.06%和12.59%)比较,差异均有统计学意义(P<0.05);干预社区强化管理的高风险人群心血管病急性事件的发生比例与因病死亡(12.60%和2.76%)均显著低于对照社区(20.00%和4.73%),差异均有统计学意义(P<0.05)。结论定诊医生的干预在急性事件的防治方面有更明显的优势;该模式下的高血压社区规范化管理能有效地降低高风险患者及高血压人群血压水平,改善患者的健康状况,促进社区高血压人群防治效果。
Objective To study and evaluate the application of this model in the management of community hypertension by establishing a clinician model. Methods From October 2010 to January 2011, hypertensive patients with diagnostic criteria of “Guidelines for Prevention and Treatment of Hypertension in China (2005 Revised Edition)” of 7 communities in 2 communities under the jurisdiction of 7 towns were randomly selected for study Subjects were randomly divided into intervention group (762 cases) and control group (676 cases) for community intervention study. On the basis of the implementation of standardized management, the intervention group established a clinician management model for community health service centers and implemented intensive management on key populations with high cardiovascular risk levels and above. Comparison of changes in blood pressure, risk factors control, death due to illness, acute events and so on. SPSS 20.0 software t test, χ2 test. Results After five years of management, the average SBP and average DBP of the intervention group decreased by 12.41 and 6.71 mm Hg respectively, while the control group decreased by 9.85 and 6.34 mm Hg, respectively, with significant differences (P <0.05). Compared with the control group, SBP were lower than the control group, and the advantages of intensive management were more obvious. In the intervention group, the rates of weight loss, smoking cessation and alcohol abstinence were 18.40%, 20.81% and 22.14% respectively, which were significantly lower than those in the control group (7.14%, 10.06% and 12.59% ) (P <0.05). The incidence of cardiovascular events and death due to illness (12.60% and 2.76%) were significantly lower in the high-risk community with intensive management than those in the control community (20.00 % And 4.73%), the differences were statistically significant (P <0.05). Conclusion The intervention of clinicians has more obvious advantages in the prevention and treatment of acute events. Standardized management of hypertensive community in this mode can effectively reduce the blood pressure of high-risk patients and hypertensive patients, improve their health condition and promote community high Blood pressure crowd control effect.