摘要
目的比较在基层医疗机构中引入医务社会工作干预和传统干预对社区高血压患者生活质量及心理生理指标的影响效果。方法选取2013—2015年北京铁营社区卫生服务中心建档的高血压患者及同期在铁营医院就诊的高血压患者,分为社工干预组(来自榴香路以东5个居委会,n=491)和传统治疗组484例(来自榴香路以西4个居委会,n=484)。两组均采用常规药物及非药物治疗(一般临床宣教、饮食及运动指导),社工干预组在此基础上对伴有焦虑、抑郁障碍的高血压患者实施一对一的个案服务,招募高血压患者实施7~10人一组的小组活动。社工干预组491例患者分9个组参加社区活动。两组分别于干预前、干预10个月时测定血压,使用健康状况调查问卷(SF-36)、生存质量测定量表简表(WHOQOL-BREF)、Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)评定患者的生活质量、焦虑、抑郁情况。结果 20例患者接受了个案服务,焦虑减轻率为68.8%(11/16),抑郁减轻率为83.3%(10/12)。社工干预组高血压临床控制率为34.4%,高于传统干预组的18.8%(χ~2=27.551,P<0.05)。社工干预组干预后SF-36评分、WHOQOL-BREF总分高于干预前(P<0.05)。结论医务社会工作对社区高血压患者进行个案服务、小组活动、社区活动干预后,高血压患者生活质量、心理、情绪方面有明显改善,有效提高了社区高血压控制率。
Objective To investigate the effects of medical social work versus traditional intervention delivered in grassroots medical institutions on the quality of life and control of psychophysiological indices of community-dwelling hypertensive patients,and to explore the factors affecting the effects of medical social work in chronic disease management.Methods We enrolled 975 consecutive hypertensive cases who were documented in Tieying Community Health Service Center and treated in Tieying Hospital of Fengtai District Beijing between 2013 and 2015,including 491 cases in the medical social work intervention group(from 5 neighborhood committees on the east of Liuxiang Road)and 484 cases in the traditional treatment group(from 4 neighborhood committees on the west of Liuxiang Road).Both groups received the conventional medical treatment combined with traditional non-drug intervention(common health education,dietary and exercise guidance).Additionally,for patients in the social work intervention group,one-on-one psychological counseling was provided for those with anxiety and depression,group activities were carried out in groups of 7-10 individuals on the basis of recruitment and voluntary registration,and community activities were conducted in all of them(in 9 subgroups).At baseline(before intervention)and post-intervention(10 months later),we measured their levels of blood pressure,health status〔by adopting the Short Form(36)Health Survey(SF-36)〕,quality of life status〔by using the World Health Organization Quality of Life Scale Brief Version(WHOQOL-BREF)〕,anxiety status〔by using the Zung Self-Rating Anxiety Scale(SAS)〕and the depression status〔by using Zung Self-Rating Depression Scale(SDS)〕.Results Twenty patients received the one-on-one psychological counseling.Of them,those with anxiety displayed 68.8%(11/16)response rate,and those with depression showed 83.3%(10/12)response rate.The clinical control rate of hypertension in the social work intervention group was 34.4%,which was higher than the 18.8%
作者
孙培云
刘宏
王振涛
常青
谢敏丽
王亚丽
SUN Pei-yun;LIU Hong;WANG Zhen-tao;CHANG Qing;XIE Min-li;WANG Ya-li(Department of Neurology,Tieying Hospital of Fengtai District Beijing,Beijing 100079,China)
出处
《中国全科医学》
CAS
北大核心
2018年第6期719-723,共5页
Chinese General Practice
基金
北京市科委首都市民健康培育项目(Z131100006813014)
