Grading Intervention And Evaluation Of Hypertension Patients’ Self-management Under Medical Conjoined Structure

Objective:The self-management evaluation scale of hypertension patients was improved and its reliability and validity were tested.At the same time,this scale is used to evaluate the intervention effect of different intervention methods on self management of hypertensive patients,and to provide effective intervention model and a good reliability and validity evaluation tool for the study of self management of hypertension patients in the future.Methods:This study is divided into two parts.The first part: the improvement of the self-management evaluation scale of hypertension patients.Based on a large number of domestic and foreign related literature,based on the social cognitive theory,the scale list entry pool is constructed,through expert consultation and small sample test form tentative version scale,through the questionnaire survey of 118 patients with hypertension and the test of the validity of the scale,to construct the final version of the scale.The second part: the evaluation of the effect of classified intervention on hypertension patients.By random sampling,120 elderly patients with high blood pressure in a three a general hospital were randomly divided into two groups,with 60 subjects in each group,and the intervention group was treated by the hierarchical intervention model based on medical couplet,that is,the hospital community family hierarchical management model,and the control group used the conventional management model.After intervention,the intervention effects and cost-effectiveness of the two intervention modes were compared.Results:1、 The scale of improved results: two rounds of expert consultation positive degree were 88%,100%;expert opinion authoritative degree of Cr is 0.92,the contentof the consultation expert judgment according to Ca is 0.92,the degree of familiarity with the content of the consultation of experts Cs 0.92;expert opinion coordination degree is 0.356 ~ 0.457,the P value is less than 0.01.The Cronbach ’S a coefficient of the overall scale was 0.890,and the retest reliability of the interval two weeks was0.914;each item content validity index(I-CVI)for 0.857~1.000,the overall index of content validity(S-CVI)was 0.90,the correlation coefficient between the scale and the overall scale of each dimension is 0.50 ~ 0.80,the correlation coefficient between dimension every 0.20 to 0.50;the application of exploratory factor analysis,selects 6factors,cumulative variance contribution rate was 75.794%.2、Grading intervention results: baseline survey of two groups of patients did not differ significantly,with comparable.After the intervention,the scores of each dimension and the overall scale of the self-management scale of the intervention group were improved obviously,cognitive self-management,monitoring self-management and diet self-management 3 dimensions increased significantly(P<0.05),but the movement of cognitive self-management,medication selfmanagement 2 dimensions have no significant difference(P>0.05);control group cognitive self-management,exercise self-management,medication self-management3 dimensions scores and overall scale score is improved,but the effect was not significant(P>0.05),monitoring self-management and diet self-management 2dimension scores decreased,there is no significant difference(P>0.05).In group comparison,the scores of each dimension in the intervention group and the score of the overall scale have been improved,cognitive self-management,monitoring self-management and diet self-management 3 dimensions are obviously improved(P<0.05),however,there are no significant changes in the two dimensions of exercise self-management and medication self-management(P>0.05).In addition,compared with pre intervention,the value of systolic and diastolic pressure in the intervention group decreased(P<0.05),and the two indexes of systolic and diastolic pressure in the control group were lower,but the difference was not obvious(P>0.05).The comparison between the groups showed that the intervention group had better intervention effect and the systolic and diastolic pressure values of the intervention group were lower than those in the intervention group.In the control group,thedifference was obvious(P<0.05).Conclusions:1、Hypertension self-management evaluation scale has good reliability and validity.It can provide a good research tool for self-assessment of hypertension patients,and provide a reference for clinical research of chronic diseases.2、The two modes of intervention in hypertensive patients all have good intervention effect,which can enhance the self management of hypertension patients and stabilize their blood pressure values.However,the intervention effect of the hospital community family hierarchical management model is obviously better than the conventional management model,and has a better cost-benefit ratio.