Study On The Web-Based Self-Management Interventions Model For Community Hypertensive Patients

[Objective] A self-management interventions model for community hypertensive patients based on web information technology, patient-centred healthcare and combined self-management of patients and clinical healthcare support was established, aiming to manage community hypertensive patients effectively, reduce risk of cardiovascular disease and of total early death, and increase the life quality of patients.[Methods] Guided by social cognition and self-efficiency theory as well as theories of patient-centered and patient empowerment, a web-based self-management interventions model for community hypertensive patients was established by consulting to the Chronic Care Model. Subsequently, a community-based randomized controlled trial (RCT) was carried out and the effect of web-based self-management interventions model for community hypertensive patients was evaluated through the combined qualitative and quantitative analysis. The RCT objects were satisfactory primary hypertension volunteers from10community health service centers in Wuhan City. They were screened through blood pressure, accomplished baseline survey and signed informed consents. These recruited hypertensive patients in same community were allocated to intervention group and control group randomly. The intervention group receives both usual three-level management from community and web-based self-management interventions, while the control group only receives usual three-level management from community.3months later, both groups were surveyed again with the baseline questionnaire and qualitative interview outline to evaluate the effect of web-based self-management interventions.[Results] According to the test, no statistical difference was found between the intervention group and control group in term of social population informatics variable and baseline outcome variables, indicating these two groups were comparable. After3months interventions, both intervention group and control group witnessed decrease in systolic pressure and diastolic pressure outcome comparing with the base line. The systolic pressure and diastolic pressure of intervention group decreased more significantly (7.9mmHg and2.2mmHg respectively), both having statistical difference (P<0.05). Both intervention group and control group increased their blood pressure control rate, increasing by46.6%and23.2%respectively. However, intervention group achieved23.4%higher blood pressure control rate comparing with the control group, existing statistical difference (p<0.001). The body mass index (BMI) of both groups decreased with the intervention group decreased0.05more than the control group, having statistical difference (p<0.001). Intervention group increased their aerobic exercise time and improved communication with doctors comparing with base line, while the control group decreased. The variation of these two groups has statistical difference (p<0.001). The quality of life (QOL) of intervention group increased after3months interventions, while that of control group decreased, having statistical significance (p<0.001). Although both intervention group and control group improved their self-efficiency, waistline, stretching and strengthing exercise time, cognitive symptoms management, health care utilization, etc., there’s no statistical difference observed between them (P>0.05). In addition, in the intervention group, significant differences of login times of web interventions system were observed between patients persisting to the end of study and patients dropping out of the study (14.22times and8.14times), which is of statistical significance (P<0.05). Based on qualitative interview, this paper discovered that the web-based self-management interventions of community hypertensive patients increased patients’knowledge, skills and confidence and improved their health behaviors, increasing the management efficiency of community hypertensive patients as well as service quality and strengthening doctor-doctor communication as well as doctor-patient communication. Online health education, individualized guidance and evaluation, discussion group and reminder are believed as the most useful interventions by participants. However, this web interventions also has some shortages in application, such as time-consuming, inadequate popularity of information expression on websites, etc.[Conclusions] The web-based self-management interventions model for community hypertensive patients can lower blood pressure, increase blood pressure control rate, reduce BMI, increase patients’ knowledge, skills and confidence, establish close doctor-patient relationship, improve self-management behavior and life quality of patients, and increase community hypertension management efficiency as well as service quality. Therefore, the individualized and interactive web-based self-management interventions model for community hypertensive patients integrated with online health education, individualized guidance and evaluation, discussion group and reminder can be viewed as an effective disease management model.[Innovations] It is the first one who established a web-based self-management interventions model for community hypertensive patients that applies the Chronic Care Model, combines self-management and clinical healthcare, cooperates among multi subjects, patient-centred healthcare and integrates with online health education as well as individualized guidance and interventions in China. Furthermore, it is the first one who carried out RCT of web-based self-management interventions for community hypertensive patients and achieved good results.