摘要
目的:评价依托乡村医生实施心血管疾病规范化管理的效果,为制定有针对性的规范化管理措施提供参考依据。方法:本研究依托"中国农村健康行动"项目中来自山西分中心的2个县12个村接受了该项目由44名乡村医生规范化管理的高危个体作为研究对象,共纳入651例患者。规范化管理包括:检出高危患者、循证治疗、定期随访(1次/月)和及时转诊。分析高危人群血压控制率、吸烟率、按时服药率、低盐饮食率随随访时间的变化趋势。采用广义估计方程分析进行重复测量资料的多因素分析。结果:651例患者纳入数据分析,随访次数总计10 274人次。(1)血压控制率:从首诊到第6次随访,血压控制率由33.64%提高到80.53%(P<0.01);(2)吸烟率:从首诊到第15次随访,吸烟率由66.05%下降至52.04%(P<0.01);(3)按时服药率:由82.64%提高到98.43%(P<0.01);(4)低盐饮食率:由67.74%提高到99.84%(P<0.01)。(5)影响血压控制率的多因素分析结果显示,除性别间血压控制率差异无统计学意义外,年龄、体重指数、随访次数、按时服药、低盐饮食和吸烟均为影响血压控制率的因素,尤其是按时服药是对血压控制率影响较大的因素(β=1.224,P<0.01)。结论:依托乡村医生对心血管疾病高危人群进行规范化管理是一种有效的心血管疾病预防途径,可以帮助高危患者控制血压,管理过程中要结合相关影响因素,采取有针对性干预措施,以获得最佳干预效果。
Objectives： To explore the effects of standardized management among high risk cardiovascular patients in rural areas and to supply data facilitating the establishment of targeted effective strategies to reduce the cardiovascular events in this population.Methods： Data from the present study were derived from the ＂China Rural Health Action＂. A total of 651 eligible patients from 12 villages of 2 counties（6 townships in each county and 1 village in each town） from Shanxi province, who received standardized management by 44 village doctors, were enrolled in this study. Standardized management refers to detection of high risk patients, evidenced based therapy, regular follow-up（once per month） and timely transfer to higher level hospitals. Changes on the prevalence of blood pressure control rate, smoking, medication adherence and low-salt diet during the follow-up period were analyzed. Results： The total follow up time was 10 274. Blood pressure control rate was significantly increased at the 6 th follow up as compared to the baseline level（80.53% vs 33.64%, P〈0.01）. Smoking rate was significantly lower at the 15 th follow up as compared to baseline level（52.04% vs 66.05%, P〈0.01）. Medication adherence increased from 82.64% at baseline to 98.43% at 1 st follow up and thereafter（P〈0.01）. Percent of low-salt diet increased from 67.74% at baseline to 99.84% post 1 th follow up（P〈0.01）. Multiple regression analysis showed that age, BMI, follow-up times, medication adherence, low-salt diet and smoking are the determinants affecting the blood control rate.Conclusions： The standardized management operated by village doctors is aneffective strategy to prevent and treat the cardiovascular diseases and effectively controls the blood pressure, targeted management based on controlling related risk factors could further improve the efficacy of standardized management in individual patient.
作者
李志芳
段培芬
刘新太
姬忠保
冯向先
武阳丰
LI Zhi-fang;DUAN Pei-fen;LIU Xin-tai;JI Zhong-bao;FENG Xiang-xian;WU Yang-feng(Office of Epidemiology,Department of Public Health and Prevent Medicine,Changzhi Medical College,Changzhi（046000）,Shanxi,China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第8期792-796,共5页
Chinese Circulation Journal
基金
中国农村健康行动(HHSN268200900027C)
关键词
农村
心血管疾病
规范化管理
Rural areas
Cardiovascular diseases
Standardized management
