| BackgroundHypertension is a common Cardiovascular disease, and make primary functions in the disease development of cerebrovascular disease, ischemic heart disease, heart and kidney failure.It’s also subject to serious complications. The Shanghai Noncommunicable Disease and Risk Factor Surveillance carried out in 2007 showed that the number of hypertension patients has reached 23.6%. The prevention and treatment for hypertension to control blood pressure and risk factors is a matter of great urgency.The foreign experience and national conditions indicate that, the method of community-based comprehensive prevention and control for hypertension is effective to accomplish the goal above. In 2004, Shanghai published a guide named "Guidelines in Community-based prevention and control for hypertension in Shanghai", in 2008 Shanghai Center for Disease control and Prevention set up a detailed-management for the hypertention building on past achievements of hierarchic classification management, and Xuhui District is one of the participants.ObjectiveTo evaluate the medium-term effect of Disease Management Program (DMaP) for Hypertension in XuhuiCommunity, and explore the management mode of hypertension which suits for the community in Shanghai.Methods3 communities were selected as participants, and 800 patients totally were recruited intervention 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. Through follow-up the physical examination was taken and the information of health-related behaviors, knowledge awareness, and compliance were collected at baseline and every 12 months in form of 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. The evaluation time was from September 2008 to September 2012.Results1 general conditionsThere were 799research subjects at baseline while 4 years later 167 reasearch subjects lost of follow up.The loss ratio of follow-up reached 20.9%. The loss ratio of the intervention group was higher than that of the control group. The two group were not significant in age, course of disease and medical fee (p>0.05), while they were tatistically signigicant in sex (p<0.001).2The 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 of the intervention group was more than that of the control group.The abdominal circumference was significantly decreased in intervention group (P<0.001), and the rates of abdominal circumference lowering to meet the normal was also significantly increased (P<0.001), while the control group had no significantly change. The rates of BMI lowering to meet the normal were significantly increased in intervention groups (P<0.001).After one year’s intervention, the serum potassium, CR, Hdl-c and uric acid were remarkably reduced in intervention group, while the serum potassium and Hdl-c were significantly decreased in control group (p<0.05).3 Hypertension knowledge awarenessThe awareness of diagnostic criteria of hypertension, blood pressure value to meet the normal in intervention group was significantly increased 4 years later, both than baseline and than that in control group.4 Health-related behaviorsThe rates of smoking decreased and the number of cigarettes smoked decreased in intervention groups 4 years later (P<0.05).After 4 years, the average daily intake of salt, vegetable oil and animal oil was decreased in intervention group (P<0.001), yet soy sauce was decreased in control group. The reduction of the tegetable and animal oil of the intervention group was more than that of the control group (P<0.05).The average daily time of walk increased in two groups 4 years later (P<0.05). But the average daily meditation time of control group was increased than before(P<0.05). After 4 years, the rates of moderate physical activity more than 5 days and walk more than 5 days were significantly increased in control group.5ComplianceThe rates of "medication now" and the score of doctor follow-up in intervention group was increased 4 years later (P<0.001), while the bad medication habits were significantly decreased o The ratio of regular follow-up and the score of medical follow-up were significantly increased in intervention group 4 years later. The health education forms of "follow-up education", "poster foldout" and "mass media" had no statistical difference between the intervention group and the control group.Conclusion1. DMap was beneficial to lowering blood pressure, raising the rate of blood pressure reaching the target and reducing hypertension modifiable risk factors. However, except the reduction of blood pressure, the difference 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 a 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 increased of DMaP was larger than that of the original management for hypertension.4. DMap had a great effect on medication compliance. The patients of DMap had a high acceptance of health education compared with the original management for hypertension. |
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