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Evaluation Of The Effect Of Controlling Blood Pressure In The Elderly Patients With Hypertension In Rural Areas Through The Training Of Village Doctors

Posted on:2017-05-11Degree:MasterType:Thesis
Country:ChinaCandidate:C C ChenFull Text:PDF
GTID:2284330488452329Subject:Social Medicine and Health Management
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BackgroundHypertension is the most common chronic disease, mainly characterized by elevated arterial pressure and associated with cardiovascular, blood vessels and other organs of the body changes in systemic disease. It is the main risk factor for stroke and coronary heart disease. With the rapid development of the global economy, overweight, obesity, poor living habits, lack of physical activity and other factors are gradually increasing, and hypertension has become a global public health problem, which has a great impact on human health. In recent years, with the development of urbanization in our country, the living standard of rural residents has improved significantly, the diet structure has also changed greatly, and the blood pressure of rural residents is increasing. The fourth report of the total health service points out that the prevalence of hypertension in rural areas of China reached 38.5%, which is a major chronic disease affecting the health and quality of life of rural residents. The rural residents with little education, lack the concept of prevention, and the health conditions are relatively backward. So,there are generally poor compliance, low awareness of the situation and associated severe hypertenaion comolications,which make the prevalence rate of hypertension in rural areas remain high. Village level medical institutions are the basis of the protection of the three level medical and health care network in rural areas, and also the main places for residents to seek medical and health services. In rural areas, the rural doctors are the main health protectors of the local villagers. Their duty is not just being a medical personnel,but also bein in charge of the health management of chronic diseases such as hypertension. They played a significant role in reducing the incidence of hypertension in rural areas.ObjectiveThis research performed five times training for intervention village doctors from July 2013 to July 2014 to enhance the level of hypertension-related knowledge and skill in Shandong Province to evaluate the changes of hypertension-related knowledge, beliefs and behaviors in the elderly hypertensive patients before and after the intervention, as well as the decline of control level, evaluation on the effectiveness of intervention, and propose strategies for the prevention and treatment of elderly patients with hypertension in rural areas.MethodsThe design type of this study is the cluster randomized controlled trial, elderly hypertension patients aged 55-75 years old in rural area were selected as a group. We randomly selected 8 intervention villages,4 control villages and performed the intervention from July 2013 to July 2014. The direct object of the intervention is the village doctors. The effect of the village doctortraining program is assessed by the evaluation of the situation before and after the intervention of the middle aged and elderly hypertensive patients. The evaluation object was randomly selected in October 2009 Shandong University research base (Pingyin county, Liangshan county and Junan county) health examination were detected of 55-75 years old patients with hypertension (Self-reported hypertension patients and a measure of the patients with high blood pressure).Interventions include:training in the rational use of antihypertensive drugs, training in rational use of basic medicine, county hypertension expert case training (posters, etc.),as well as health education and promotion methods and skills training. The intervention of village doctors completed a total of 5 training, with the basic public health services, and performed 4 health intervention of patients with hypertension of the village.Research ResultsRural doctors play an important role in the prevention and control of hypertension among rural residents. The training of rural doctors can increase the knowledge of hypertension prevention treatment of rural doctors, and reduce the blood pressure level of rural areas. The results showed that eight intervention village doctors in rural hypertensive scores were significantly improved by the average score increased from 58.75 points to 83.13 points, four control village doctors in rural hypertension average score increased from 53.75 points to 58.75 points and did not increase obviously. After the intervention, the intervention group patients systolic pressure and diastolic blood pressure were decreased (11.79+2.19) and (7.24+1.14) mm Hg, were higher than the control group (10.72+25.39) and (6.44+12.36) mm Hg, the blood pressure levels were effectively controlled. The control rate of blood pressure in intervention group increased from 12.2%to 40.1%, and the growth rate was higher than that 19.3% of the control group (OR= 1.777, P<0.05). Prevalence of Level 1 hypertension decreased from 50.5% to 42.5%, the drop rate was higher than that 2.5% of the control group. Prevalence of Level 2 hypertension decreased from 23.9% to 10.6%, the drop rate was higher than that 7% of the control group Prevalence of Level 3 hypertension decreased from 13.3% to 6.8%, and the control group decreased from 15.4% to 5.6%. Different characteristics of hypertension patients has the different intervention effect. After the intervention, the intervention group of male hypertensive patients with systolic pressure and diastolic blood pressure were decreased (13.06+22.88) and (8.64+11.70) mm Hg, which were higher than that of female (10.66+20.85) and (5.99+10.99) mm Hg. After the intervention, the intervention group of≤65 years hypertensive patients with systolic pressure and diastolic blood pressure were decreased (10.84+19.58) and (7.10+ 11.11) mm Hg, were lower than the> 65 years old (12.49+23.78) and (7.41+11.56) mm Hg.The intervention made the compliance of the intervention group improved significantly. The intervention group with good compliance ratio from 21.4% to 28.5%, the growth rate was higher than that 4% of the control group (OR= 1.292, P >0.05). The interventions can improve the knowledge, attitude and behavior of hypertension patients in rural areas. Hypertension-related knowledge rate of the intervention group from 42.34% to 55.11%, the growth rate was higher than that 1.75% of the control group (OR= 1.623, P<0.05). Hypertension-related beliefs rate of the intervention group from 76.8% to 94.3%, the growth rate was higher than that 7.7% of the control group(OR= 3.298, P<0.01). In six hypertension related behavior problems, both intervention group and control group had four problems in behavior formation rate are increased (P<0.05). After DID analysis, OR= 1.245, but there was no statistical significance (P<0.05)Conclusions and Suggestions:The intervention methods of training the knowledge of hypertension and health education skills of the rural doctors in Shandong province can improve the blood pressure control rate of hypertension patients in rural areas, drug treatment and lifestyle changes compliance, the awareness level of hypertension related knowledge, treatment level of hypertension related attitude, etc, and have a clear effect.To improve the management of patients with hypertension in rural areas, I put forward the following suggestions:1. Strengthen the training of rural doctors’ knowledge related to hypertension.2. Strengthen rural doctors’ attention to health education, change the only defination of disease treatment, and raise awareness of rural doctors in the disease prevention, making rural doctors more active in providing health education.3. Strengthen the health education skills of rural doctors.4. On the basis of improving knowledge and skills of rural doctors, enhance the management process of hypertension patients..
Keywords/Search Tags:the midlle-aged and elderly rural residents, rural doctors, hypertension, intervention effect, evaluation
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