| Background:Along with development of economy, life span and the variety of the life style, the residents’ disease table of country took place a graveness variety, the death preface of various nasty and chronic infectious disease declined from the first to the tenth, but now cardiovascular disease, cancer, diabetes and other chronic represented by non-communicable disease(call chronic disease as follows)has already become the important public hygiene problem which seriously threat people’s health of our country. About 1.3 myriad peoples of the whole country is dying in chronic disease everyday, which is above 70% of national total death and the city region is up to above 85%. Becouse of the long course, the low cure rate, the high recurrence rate, poor prognosis and the high morbidity, chronic disease has become the high burden of the families and the society.Hypertension is a common clinical syndrome with increasing systemic arterial blood pressure, is a systemic disease with heart., brain and kidney ’s functional or organic changes. The number of hypertension patients i n china is up to 160 million.As an industrial development and rapid economic development city with serious aging population, hypertension and other cardiovascular diseases of Shanghai can not be optimistic.Domestic and foreign experience shows, the most effective way to control high blood pressure is prevention and control of community Of great importance in the government sector, has introduced the "Shanghai Community Hypertension Prevention Guide" and other guidance documents. Prevention and treatment of high blood pressure in the community has gradually strengthened. But with the three increasingly sophisticated network of city-Disease Prevention and Control Center-Community, the continuous improvement of six integrated functions and community team service model and the full implementation of family health responsibility, new requirements has put forward to prevention and control of hypertension in the community.Found by searching study abroad, a lot of study studied integrated intervention of hypertensive disease. This study based on the current management model, add the details of the various management through the establishment of health commissioner positions, the use of patient self-management, strengthening two-way referral and other methods to further improve the quality of the management of hypertension in the community.Objective:By appropriate measures to adjust and improve all the details of the management of hypertension in this area, explore the appropriate management of the area and analysis the effect of this mode.Methods:In 22 communities in Fengxian District, there were 5 communities requiring in the geographical location, population stability, economic level, hospital size, health service delivery capability to maintain balance,they were:Wuqiao, Zhuanghang, Qianqiao, Hongmiao and Zhelin. Among them, Random determined are the Zhuanghang and Hongmiao community, they were randomly divided into intervention group (Zhuanghang) and a control group of community (Hongmiao). According to the mastered the hypertensive patients of two communities, two community through the management of patients with hypertension were 820 people and 613 people. They will be randomly divided into intervention group and control group. According to the recruitment criteria, intervention communities recruit 600 patients.200 patients were recruited in control community. Patients in the intervention group signed a contract with community health service center including health commissioner and carrying out individualized health education and other forms of new management model of high blood pressure. Control community-recruited patients were still under the original model of this district, analysis the effect of the intervention. In the management process, the intervention group died 4 people, lost 34 people, finally 429 in examination stage,. The control group during the study lost 20 people, 131 people participate in physical examination lastAll data were analysis by using SPSS13.0 software package.Results:1、Before intervention, the two patient groups sex, culture degree, age and other demographic characteristics have no statistically significant difference. Between the two groups, weight, BMI, diastolic blood pressure, blood pressure control, " hypertensive diagnostic criteria" and other 7 related knowledge," all time comply with medication " and other 5 related behavior adoption rate, willing to accept community health service and the satisfaction rates of provide community service were not statistically different, two sets are balanced comparable.,2、Before the intervention,, heart rate, mean circumference of control group were higher than those in the intervention group, there was statistically significant difference. The systolic blood pressure mean values of the intervention group were higher than those in the control group, there was statistically significant difference between the two groups.3、After the intervention, each physiological indications of two groups have no di fference, so i t cannot be described in these indications on intervention effect difference, further compared the difference of physiological indications of the two groups of patients before and after the intervention, body weight, BMI, diastolic blood pressure, heart rate change in the amplitude of two groups showed no difference. Abdominal circumference and systolic blood pressure changes were statistically difference. Combined with the two group at baseline for comparison:the decrease of abdominal circumference in the control group were higher in the intervention group, systolic blood pressure decrease in the intervention group were higher than in the control group.4、After the intervention, hypertension excellent rate of 60.4% of the intervention group patients is higher than that of control group of 49.6%, and there was a statistically significant difference between.5、After the intervention, the awareness rate of "quit smoke", " limit wine" and" hypertensive complications (eight of awareness in four or more)" of the two groups has differences, other indicators are still no difference6、After the intervention, rates of the intervention group patients all time comply with medication and exercise regularly was higher than those in the control group, there was a statistically significant difference between the two indicators, the intervention effects of the intervention group is better than in the control group. But the monthly 1-2 measured blood pressure, alcohol and salt intake is still no difference.7、Af ter the intervention, will ingness to accept the community health service and satisfaction rates of provide community service of intervention group were higher than those in the control group, there was statistically significant difference.Conclusion:Based on the existing management, this study set up the health commissioner who played the supervision and liaison role, its relevance, individual ity and strengthen health education activities have significantly improved the part of patient’s knowledge. Emphasis on patient self-management and family support system increased behavior adoption rate, its community responsibility team and contractual management form achieve a good doctor-patient interaction, acceptance rate of patients of the community health service and satisfaction rate was increased, This research promote the management of hypertension in Fengxian District, but its long-term effects need further study. |
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