| ObjectiveTo evaluate the medium-term effect of Disease Management Program (DMaP) for Hypertension in Shanghai Community, and explore the management mode of hypertension which suits for the community in Shanghai.Methods27 communities were selected as intervention group and 19 communities were selected as control group from 19 districts in Shanghai.800 patients were recruited in each district with the ratio of 3:1 in the intervention and the control group. The intervention group conducted DMap in addition to the original management for hypertension, while the control group was only in progress of the original management. The physical examination was taken through follow-up. The information of hypertension health-related behaviors, knowledge awareness, and compliance were collected at baseline and every 12 months through questionnaires. Comparisons of pre and post and parallel in two groups were used in all assessment items, and the relationship between hypertension health-related behaviors, knowledge awareness, medication compliance and the rate of blood pressure lowering to meet the normal was also observed. The evaluation time was from September 2008 to September 2012.Results1 The physical examinationThe blood pressure was significantly decreased and the rates of blood pressure lowering to meet the normal were significantly increased in both groups 4 years later. But the reduction of systolic blood pressure and diastolic blood pressure of the intervention group were more than that of the control group. The △ SBP of two groups were (8.72±13.74) mmHg and (6.60±13.26) mmHg respectively (P<0.001). The △ DBP of two groups were (5.38±9.04) mmHg and (4.42±8.01) mmHg respectively (P<0.001).The abdominal circumference was significantly decreased in both groups (P<0.001). The rates of abdominal circumference lowering to meet the normal were significantly increased in the intervention group (P<0.001) while the control group had no significantly change. The rates of blood pressure lowering to meet the normal of those whose abdominal circumference lowering to meet the normal were higher than those whose abdominal circumference not lowering to meet the normal in two groups (P<0.05).The rates of BMI lowering to meet the normal were significantly increased in both groups (P<0.001). The rates of blood pressure lowering to meet the normal of those whose BMI lowering to meet the normal were higher than those whose BMI not lowering to meet the normal in the intervention group (P<0.001).2 Health-related behaviorsThe rates of no smoking increased and the number of cigarettes smoked in smokers decreased in both groups 4 years later (P<0.05). However the number of cigarettes in the intervention group was less than in the control group, and the reduction of cigarettes in the intervention group was more than in the control group (P<0.05). The rates of blood pressure lowering to meet the normal of no smokers were higher than smokers in two groups (P<0.05).After 4 years, the average daily intake of salt, soy sauce and vegetable oil was decreased in two groups (P<0.001). Yet the average daily intake of the intervention group was less than that of the control group 4 years later (P<0.05). Furthermore, the rate of people who had good habit of three meals every day in the intervention group was more than in the control group (P<0.001). There was a negative correlation between the average daily intake of salt, vegetable oil, animal oil and the rate of blood pressure lowering to meet the normal (r=-0.060,-0.024,-0.043; P<0.05).The average daily time of moderate intensity exercise and walk increased while the average daily time of meditation decreased in two groups 4 years later (P<0.05). But the average daily meditation time of intervention group was less than that of the control group (P<0.05). Compared of the exercise frequency which was more than 5 days every week, the intervention group’s high intensity exercise, moderate intensity exercise and walk was more than the control group (P<0.05). The rate of exercise frequency more than 5 days every week of moderate intensity exercise and walk of those whose blood pressure reached the target was higher than those blood pressure not up to the target in both groups (P<0.05).3 Hypertension knowledge awarenessAlthough the awareness of hypertension risk factors, complications and preventive principles was significantly increased in both group 4 years later (P<0.001), the awareness scores of the intervention group were better compared with the control group (P<0.001), which was the same with the scores of disease and blood pressure (P<0.001). There was a positive correlation between the awareness of hypertension risk factors, complications, preventive principles and the rate of blood pressure lowering to meet the normal in the intervention group (r=0.089,0.046,0.1073;P <0.001).4 Compliance The medication compliance increased in two groups 4 years later(P<0.05), but the interventio打 group was better than the control group(P<0.0(U). Compared with the intervetic patiets whose blood pressure not lowering to meet the normal, the rates of "medication now" and "medication adherence at all the time" of those whose blood pressure reached the target were higher(P<0.001). The score of health education in the intervention group was better than the control group(P<0.001).Conclusion1.DMap was beeficial lowering Wood pressure, raising the rate of blood pressure reaching the target and reducing hypertension moable risk factor’s. However,except the reduction of blood pressure, the differece of physical examination between DMap and the original management for hypertension was not significantly.2.DMap had a great effect on promoting health-related behaviors that patients had great change in smoking, diet and exercise behaviors compared with the original management for hypertension,3.DMap was favor to improve the awareness of hypertension knowledge. The amount of rate increed of DMaP was larger than at of the original management for hypertension. 4.DMap had great effect medication compliance. The patients of DMap had a high acceptance of health education compared with the original management for hypertension.5. Controlling blood pressure was benefit from reducing hyperte打sion risk facto。,improving the awareness of hypertension knowledge and raising medication compliance. |
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