The Effect Of Case Management Model For The Compliance Of Home Blood Pressure Monitoring In Elderly Patients With Hypertension In The Community

Objective:To understand the cognitive and compliance level of home blood pressure monitoring in elderly patients with hypertension in the community;To explore the effect of case management model on the compliance of family blood pressure monitoring in elderly patients with hypertension and provide a reference for the management model for elderly patients with hypertension in the community.Methods: 1.Cross-sectional study:By using convenience sampling method,280 elderly patients with hypertension were selected in one of communities health service center in Nan ning city as the research objects.Using a self-made questionnaire on the general condition of the elderly patients with hypertension,Cognitive and behavioral pattern questionnaire of family blood pressure,Cognitive and compliance assessment questionnaire for family blood pressure monitoring,Antihypertensive therapy related attitudes and beliefs scale,Therapeutic adherence scale for hypertensive patients to investigate patients' information.Using percentages to describe patients' general information and the level of Cognitive and compliance of family blood pressure,the correct rate of using blood pressure monitor,using mean plus or minus standard deviation to describe scores of patients' Antihypertensive therapy related attitudes and beliefs as well as Therapeutic adherence.2.Intervention research:Select 60 hypertensive patients from the first stage of the investigation,which had devices of upper arm electronic blood pressure,but the monitoring of blood pressure was less than once a week,and the score of Therapeutic adherence scale was greater than 75 points.The patients were randomly divided into intervention group and control group,each group contained 34 patients,and the intervention time was 6 months.The control group received conventional hypertensive care in the community,including six lectures that about hypertension,once a month and two visits,once a quarter.The intervention group carried out the case management model on the basis of conventional hypertensive care in the community,and carried out the five stages of evaluation,planning,implementation,coordination,supervision and evaluation.In the first week,the patient were arranged to visit the nursing case management clinic for evaluation and planning.Plans were put into practice from the beginning of second week and patients were followed up by telephone every week,three months later,the patients were arranged to the nursing case management clinic for reevaluation and adjustment plan,and the weekly telephone follow-up was conducted to 6 months.Before each visit,a telephone appointment was made,and the intervention for the patient was completed by a case manager with more than 5 years of teaching experience and over 10 years of community nursing work experience.At the end of the first,third,sixth month after the intervention,the intervention effect of home blood pressure monitoring cognition and compliance,the level of antihypertensive therapy related attitudes and beliefs as well as therapeutic adherence,blood pressure,and the correct rate of using blood pressure monitor were evaluated.EPidata3.1 software was used for data entry,and SPSS22.0 software was used for data analysis.The results were statistically significant with P < 0.05.Results: 1 The family blood pressure monitoring equipment holding rate was low in the elderly patients with hypertension in the community.The holding rate of blood pressure is 57.8%(162/280);and the electronic blood pressure meter(79.6%)(129/162);Mercury sphygmomanometer 20.4%(33/162).2 The cognitive behavioral pattern of home blood pressure monitoring in elderly patients with hypertension in the community is not ideal.It mainly showed that low self-test rate and low record rate,and high proportion of not knowing the correct time of measurement,the normal value of family blood pressure and did not provide data to the doctor during the visit.3 The cognition and compliance of family blood pressure monitoring in elderly patients with hypertension in the community need improving.Up to 76.8% of patients had poor blood pressure monitoring cognition and 79.6% of patients had poor compliance with blood pressure monitoring.4 The correct utilization rate of blood pressure in elderly patients with hypertension in the community was low.Only 10.4% of patients use the blood pressure monitor correctly,and up to 89.6% can not use it correctly.5 The therapeutic compliance of elderly patients with hypertension in the community was moderate.The score of each dimension: medication adherence was(46.92 ±4.68),limit salt diet was(8.29±1.56),the exercise was(3.06 ±0.65),quit alcohol and smoke was(8.67±2.13),weight control was(3.02±0.76),emotion regulation was(8.49±2.17),control of sleep was(2.64±0.79),blood pressure monitoring was(1.85±0.71),and the score of blood pressure monitoring dimension was lowest.6 The effects of the case management model for the family blood pressure monitoring compliance of elderly patients with hypertension in the community are as the following:6.1 After intervention,blood pressure monitoring cognitive and compliance,correct usage rate of blood pressure monitor,antihypertensive therapy related attitudes and beliefs and therapeutic adherence blood pressure control in the Case management model group were improved significantly,compared with before,the difference was statistically significant.6.2 Compared with the routine community intervention group,two groups of patients in blood pressure monitoring cognition and compliance,correct usage rare of blood pressure monitor,antihypertensive therapy related attitudes and beliefs and therapeutic adherence,systolic blood pressure are statistically significant.Conclusions: 1 The cognition and compliance of blood pressure monitoring in elderly hypertensive patients in the community need improving,and interventions and guidance should be focused on patients' awareness.2 Compared with the routine management model of community,the case management model can improve the blood pressure monitoring cognition and compliance level of elderly patients with hypertension in the community better.3 Compared with the routine management model of community,the case management model can improve the correct utilization rate of blood pressure of elderly patients with hypertension in the community better.4 Compared with the routine management model of community,the case management model can improve the level of antihypertensive therapy related attitudes and beliefs and therapeutic adherence of senile hypertension patients in the community better,and has a lower blood pressure.