Hypertension Patient Management In Siping Community: The Current Situation And Management Demands

BackgroundPresently chronic diseases have become the number one killer among Chinese. As one of the most commonly-seen chronic diseases,hypertension has become a major public health concern in both developing and developed countries. Hypertension is characterized by high morbidity,high mortality,and high disability rate(known as the "three highs") and low awareness rate,low cure rate,and lower control rate(known as the "the lows").According to the National Nutrition and Health Survey of China(2004),18.8%of Chinese adults suffered from hypertension, with an absolute number of 0.16 billion,70 million more than that in 1999.The awareness rate,cure rate,and control rate of the hypertension population were 30.2%,24.7%and 6.1%,respectively.Therefore,efforts still need to be made to improve the management of community chronic diseases,the health education for comprehensive intervention,family initiative for prevention,health attitude of patients,and compliance of patients for non-drug treatments,which not only help to maintain the health of community residents,improve their life style,control blood pressure,reduce complications,but also help to lower the medical costs and the optimize the disposition of health care resources.Objects and methods1.The health records of Siping community of Yanpu District,Shanghai.2.A total of 6295 hypertension patients who were enrolled in the community health service center from 2005-2007.3.Cluster sampling was used to select 1156 hypertension patients from the four resident committees of Siping community;investigation of the knowledge,attitude and practices(KAP) was carried out.4.The 30 residents responsible for follow-up management were personally interviewed. Main findings and results1.Community health records and community-based hypertension management(1) The enrolling rate of community hypertension patients demonstrated an increasing trend,from 90.2%in 2005 to 99.1%in 2007.The enrolment mainly included the objects needing special attention.(2) There was no significant difference in the hypertension control rates of the objects needing special attention between 2007 and 2006(43.0%vs 42.8%). However,the effective control rates of group 1 and group 2 were significantly higher than that of group 3.Besides,the control rate of female patients was higher than that of male ones.2.The results of KAP investigation of community residents(1) General information.The mean age of the objects was 67.11±11.88 years old;female dominant;62.1%of the objects were above 65 years old.(2) The awareness rate,cure rate,regular medicine-taking rate,and control rate were 47.7%,88.9%,41.5%,and 37.0%,respectively.(3) Influencing factors.The awareness rate was influenced by education backgrounds and management group.Low education background and low management frequency were the major factors of awareness rate.The cure rate was influenced by gender and family history.The cure rates were higher in female residents and residents with family history than in male ones and those without family history.The regular medicine-taking rate was influenced by management period;the regular medicine-taking rate was decreased when the management period was shorter.The control rate was mainly influenced by the gender,alcohol drinking, physical exercise,body mass index(BMI),and blood pressure grade.Male gender, alcohol drinking,lack of physical exercise,BMI≥24,and high blood pressure grade were the risk factors for the control rate of hypertension.(4) Attitudes toward hypertension.91.1%of the objects thought it was necessary to have regular check-up of the blood pressure;62.4%thought hypertension preventable;82.2%thought it was necessary to have persistent medicine treatment.Among the surveyed objects,30.1%thought community hypertension management should start from adolescent patients,49.3%thought it should start from adult patients,and 20.6%thought it should start from aged patients.(5) Administration demands.We found that 63.8%objects thought it was necessary to have health education in the communities;males showed a greater interest in participating health education.3.Investigation of hypertension management demands among community residentsMajority of residents thought it was necessary to upgrade their hypertension knowledge and management ability.Rational drug therapy,updated knowledge on hypertension prevention/treatment,and guidance of physical activity were the major demands and suggestions of residents.Conclusion and suggestions1.Control of hypertension poses a serious challenge for public health in today's society,and is an important content of the six functions of current community health service,namely,the prevention,health care,treatment,rehabilitation,health education,and family planning.2.Community health service center is the basis and an important place for hypertension control and treatment.Health education and regular follow-up are the effective ways to control and treat hypertension.3.Siping community has established a network for hypertension management. Based on initial blood pressure measuring,outpatient visiting,and health records, group-based follow-up management has been practiced in the community hypertension patients.Group transfer was done annually so as to provide patients with sustainable,comprehensive,accessible health care service.