Background Hypertension is a common disease that seriously endangers the health of populations, frequently-occurring disease, is one of stroke, coronary heart disease the major risk factors. At present, China in the prevention and treatment of hypertension, the “three low, three high, three errors”, namely, (three high: prevalence rate, high morbidity and mortality is high; three low: low awareness rate, treatment rate is low, the control rate is low; three errors: do not want medication, do not tolerate no medication, no medication by your doctor) the situation has not significantly improved, the low rate of effective control of hypertension phenomenon is a widespread problem. At home and abroad a large number of studies have shown that people in the community to implement the classification of hypertension management is the crowd the key to prevention and treatment of cardiovascular and cerebrovascular diseases. Current hypertension management at different levels of remaining on the following questions, (1) Comprehensive chronic disease prevention and control capacity of the community vacancy. Community Health Workers of knowledge, lack of technical skills, general hospitals and specialist hospitals division of responsibilities, organisational structure, two-way referral mechanism and communities to monitor the operation of the network is not quite built the whole, restricted the development of community health services. (2) Lack of dynamic data, management information missing. Community Center, the household as the unit set up a health file, but the health records are now almost become a dead file, and did not track population health problems. Therefore, it cannot reflect the health record of the progress of the disease in patients with hypertension and prevention of, intervention in the situation. (3) Targeted poor health education. The health of residents and living behaviour concepts are outmoded, self-health awareness is poor, the seriousness of the harm of chronic disease awareness rate is low, the risk factors for inadequate understanding of the significance of interventions.
Objectives In response to these problems, the Beijing Chui yangliu hospital under the “Beijing cardiovascular and cerebrovascular diseases prevention and control manual” requirement, proposed “Hypertension in the community—hospital management at different levels between the test mode, ” Compliance rate and blood pressure in order to standardise management rate, lower risk levels, to reduce the risk of cardiovascular morbidity and mortality, to explore suitable for China's situation model of the integrated management of hypertension. The study through management at different levels of inclusion of 274 patients with hypertensive patients before and after their own comparative study to evaluate the model after the implementation of the hypertension prevention and control results.
Method Adopt the “Chinese Hypertension Prevention Guide” (2005 revised edition) diagnostic criteria and requirements, in December 2008–2009 years for 274 cases of hypertension management status for analysis.
Results (1) General situation: there were 129 case of men and 145 cases of women in 274 patients with hypertension, the average age of 67.3±9.4 years; Educational level is relatively high, secondary and higher educational level accounted for 81.4% of the total; In the hierarchical management process, with a total of 16 cases were lost, accounting for 5.8% of the number of standardised management, including those who refuse to measure the number of defaulters accounted for 43.7%. (2) Awareness rate: The management of the knowledge rate were significantly higher than the management of the former, the difference is still statistically significant (p<0.01), Among them, “the daily salt intake and reasonable” and “control high blood pressure measures” the most significant, awareness by management of the former increased by 16.3% and 27.9% to 65.5% and 78.7%; the management of the right to determine the standard blood pressure increased awareness rate 82.6%. The results show that, Management at different levels of behaviour change in patients with hypertension had a greater role, also targeted individual, diversified health education also exposes patients to improve the level of knowledge. (3) Management at different levels by 1 year, patients with bad habits was significantly reduced; The overall management of the rate of 94.2%, which strengthen the management of 123 cases, 114 cases of general management, management, rates were 96.9% and 91.9%. After the Management of different levels, the results showed that 63 patients of very high risk group (38.7%) down to high risk group, 26 patients of high risk group (45.6%) down to medium risk group, 8 patients of medium risk group (32.0%) down to low risk group, 11 patients of low risk group (42.3%). In the management level, strengthen the management group, 62 patients with reduced general management group, downgrade rate was 50.4%, moderate management group dropped to nine cases general management group, downgrade rate was 42.9%. After statistical analysis, management, the indicators before and after differences were statistically significant (p<0.05). (4) According to the hierarchical management standards, the number of 258 cases of standardised management, of which 220 cases of blood pressure control effect of good and can still control the rate of 85.3%. (5) 1. Comparison of blood pressure control rate was no significant difference between male and female, (p>0.05). 2. Age effects on blood pressure control rates were significantly different, which the 45–65 age group is better blood pressure control in patients, (p<0.01). Age risk factors in elderly patients is not easy to change their behaviour and lead to more complications associated with the causes of low blood pressure, low control rate of young patients with unhealthy living habits and poorer compliance. 3. Educational level influence on blood pressure control rate, differences among the groups was statistically significant, (p<0.01). High blood pressure education controls are better than low education who, due to the different education level led to their level of awareness of hypertension, attention to different degrees, resulting in the management of compliance and self-management there are differences. 4. Control of body mass index in patients with normal blood pressure within the good level of control in overweight or obese. 5. Related knowledge among the higher, blood pressure control rate. 6. Better way of life of patients control their blood pressure was higher than those bad habits blood pressure control rate. 7. Medication affect the situation on the blood pressure control rate, regular medication of patients reached their blood pressure control rate of 70.9%. 8. Management began, dangerous levels of blood pressure control rate among all groups showed no significant difference, (p<0.01). 9. Management-level influence on blood pressure control rate, difference was statistically significant lower levels of management step by step help to improve compliance rates of blood pressure, (p<0.01). (6) Whether control of blood pressure as dependent variable, a single-factor analysis of the factors was significant for the independent variable, logistic regression analysis, the results showed that: factors that affect the model results are BMI, Awareness, Lifestyle, Medication conditions and Management level (p<0.01).
Conclusions (1) Implementation of the hierarchical management model one year later, which effectively improved hypertension awareness, management and control of hypertension rates. (2) Factors that affect the model results are BMI, Awareness, Lifestyle, Medication conditions and Management level.
- Hypertensive patients
- information platform
- progressive patientcare
- model investigation
- treatment outcome