| Background and PurposeIn recent years,the prevalence of essential hypertension(EH)in China has continued to rise.The China Guidelines for the Prevention and Treatment of hypertension indicated that lifestyle interventions can effectively lower blood pressure,control other risk factors,and improve clinical conditions [1-2].Psychological stress was one of the main risk factors affecting hypertension.Studies had shown that the incidence of hypertension combined with anxiety and depression mental illness was about 15-50%,which seriously affected the quality of life [3].At present,the research on bio-psycho-social integrated medical model was mostly at the level of theory and advocacy.The combination of clinically simple and operable integrated diagnosis and treatment mode had not been formed.Based on the research results of relevant medical models at home and abroad,this study attempts to establish a physiological-psychosocial-ethical comprehensive diagnosis and treatment model suitable for outpatients with essential hypertension,based on the simplicity,convenience and operability.The core link was hypertension physicians and psychotherapists form a medical team that follows the patient-centered,informed consent ethics principles and conducts a comprehensive assessment of the patient’s mental and psychological status,social situation,and lifestyle through clinical psychologists.The division jointly developed individualized comprehensive treatment and division of labor intervention for the evaluation results,and compared with the control group’s routine diagnosis and treatment model to evaluate its efficacy in patients with essential hypertension.Objects and methodsSelected patients with essential hypertension who were admitted to our hypertension clinic from September 2016 to September 2017.used the prepared Comprehensive Diagnosis and Treatment Model Assessment and Indicators Manual(see Annex B)to take comprehensive assessment of the patients.Screen out the positive questionnaires in the assessment questionnaire for lifestyle,psychological status,and social conditions,and those who met other criteria for inclusion.the essential hypertension patients were divided into intervention group and control group by random number table.the general data of essential hypertension were recorded.measuring blood pressure,assessing lifestyle,psychological status,and social situation,the control group used conventional diagnosis and treatment mode,including drug therapy combined with general health education,and the intervention group used a physiological-psychological-ethical comprehensive diagnosis and treatment model based on the control group.the hypertension doctor and the psychotherapist jointly completed the diagnosis and treatment process.According to the comprehensive evaluation results of the intervention group,the positive items selected by the intervention group were treated with individualized comprehensive treatment and division of labor intervention,including drug treatment,health education,psychotherapy,and ethical humanistic care.Compared the blood pressure control rate,medication compliance,re-hospitalization,psychological status,social situation,lifestyle,and satisfaction of the two groups,162 cases were finally completed,among them,there were 92 patients the intervention group which included 39 males and 53 females and the age ranged from 35 to 68 years old,with an average age of 54.06±9.40 years.the control group had 70 patients,which included 27 males and 43 females,aged 37-70 years,with an average age of 55.48±9.03 years.Data analysis was performed using SPSS 21.0.Results1 General data comparison: There was no significant difference in age,gender,proportion of antihypertensive drugs,duration of disease,blood pressure,hypertension,comorbidities,psychosocial status,and lifestyle(P>0.05).2 Comparison of blood pressure: the blood pressure of both groups was lower than before.The effective rate of hypertension in the intervention group with grade 1,2 and 3 were 86.2%,65%,60.9%,respectively and the effective rate of hypertension in the control group with grade 1,2 and 3 were 60%,40%,and 26.7% respectively.The difference in the effective rate of blood pressure between the intervention group and the control group was statistically significant(P<0.05).Comparison within the intervention group showed that there was a significant differencein the effective rate of blood pressure between grade 1 and grade 2 hypertension(P< 0.05),significant difference in the effective rate of blood pressure between grade 1 and grade 3(P< 0.05),and no statistically significant difference in the effective rate of blood pressure between grade 2 and grade 3(P > 0.05).3 Comparison of the number of re-hospitalizations and medication compliance: intervention group and admission of 0,1,2 or ≥ 3 the number of cases of 45,28,17,2 respectively and the control group and admission of 0,1,2 or ≥ 3 the number of cases of 28 7,13,22,respectively,the difference in the number of re-hospitalization between the intervention group and the control group was statistically significant(P < 0.05),suggesting that the number of re-hospitalization in the intervention group was lower than that in the control group.The number of good,general,and poor cases in the intervention group was 45,38,and 9,respectively.The number of cases in the control group was good,the general,and the poor cases were 25,22,and 23,respectively.There was a statistically significant difference in medication adherence between the control group(P < 0.05),suggesting that the medication adherence of the intervention group was higher than that of the control group.4 Comparison of psychological status,lifestyle and social situation: The total scores of mental state,social situation and lifestyle of the intervention group were 9,5.6±1.72 and 8.23±2.45,respectively.The psychological status,social situation and total lifestyle score of the control group were 11,6.56±1.77,9.22±3.16,the psychological status,social situation and total lifestyle score of the intervention group were lower than those of the control group(P<0.05),suggesting that the intervention group had better psychological status,social situation and lifestyle than the control group.The total score of satisfaction in the intervention group was 111.76±6.43,and the total score of satisfaction in the control group was 96.87±7.46.The total score of satisfaction in the intervention group was higher than that in the control group(P<0.05),suggesting that the intervention group was better than the control group.The satisfaction of the treatment is improved.ConclusionsCompared with the conventional diagnosis and treatment model,the comprehensive model of physiological-psychological-ethical diagnosis and treatment could significantly increase the blood pressure control rate of outpatients with essential hypertension,especially for grade 1 and 2 primary hypertension.the comprehensive model of physiological-psychological-ethical diagnosis and treatment could also improve the patient’s medication compliance,reduce the number of re-hospitalization,improve the patient’s lifestyle and improve the patient’s quality of life;at the same time,it could significantly improve the patient’s psychosocial condition and improve the patient’s satisfaction with the clinic.Established a more harmonious relationship between doctors and patients. |
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