| Objective The purpose of this research is to understand the present situation of health management and the basic situation of hypertension patients in Huai’an city. It evaluates the effect of health management for hypertension control and influencing factors, and provides the basis for further improvement of the community management of hypertension patients in the basic medical and health institutions.Method By the method of questionnaire survey in combination with physical measurement, the information of samples of 700 hypertensive patients who were 35 years old and above and participated in health management services of hypertension patients full 1 year, were collected. All the data were input by Epidata3.0 software and analyzed by SAS 9.3 software.Results 1 There were 26.4% of the whole hypertension patients under community-based management. The blood pressure control rate of hypertension patients of community-based management was 62.7%. 2 In accordance with the national basic public health service specification(2011 edition), the proportion of urban and rural patients with high blood pressure,and follow-up visits by community doctors at four times over the past 12 months was 47.50% and 42.33% respectively, and the percentage of follow-up of more than four times was 35.75% and 49.33% respectively. Compared with rural, follow-up times by community doctors in urban was higher(c2=15.38,P<0.0001).The follow-up time was 16.15±6.81 minutes for average, and that of urban and rural was 19.08±6.39 minutes and 12.22±5.20 minutes respectively, so the follow-up time of urban was longer than that of rural(t=15.15,P<0.0001). The main form of follow-up included entering a follow-up, telephone follow-up and outpatient follow-up. The guidance of diet(mainly limited guidance of salt) and physical activity guidelines were provided during follow-up, and the ratio of that was more than 90%, which conformed to the requirements of the national basic public health service specification(2011 edition). 3 The mean disease course of hypertension patients was 9.68±8.36 years, and that in city and countryside was 11.17±9.20 years and 6.92±5.57 years respectively, and the illness course of city hypertension patients was longer than in the rural(p < 0.001). Self-evaluation of health for general accounted for 56.71%, and self-reported for healthy and very healthy accounted for 29% and 2.71% respectively. 4 The awareness of hypertension related knowledge in city was higher than in rural areas(p < 0.01). The awareness rate of knowledge on hypertension criterion and salt in the recommended intake(RNI) was 72.75% and 56.39% respectively in city, and that in countryside was 37.67% and 13.33% respectively. The proportion of urban patients who understood risk factors of hypertension was 65.1%, which was higher than 35.4% of the rural patients(p < 0.01). The smoking rate and the drinking rate of hypertension patients in survey area was 14.47% and 19% respectively. Patients in city had lower rate of smoking than in rural, but there is no significant deviation in drinking between the two regions. Medication compliance rate of urban patients was 50.75%, which was higher than 40.67% of the rural patients, and the average rate of medication compliance was 46.43%. Forget to take medicine was the most important reason for the failure to take medicine on time. The proportion in urban and rural was 78.8% and 80.0% respectively, and there is no significant difference between them. 5 The hypertension patients’ BMI was 25.18±3.64 on average, and city patients’ 25.16±3.75, and rural patients 25.20±3.50. Through statistical analysis, the difference had no statistical significance(p > 0.05). The rates of overweight and obesity were 45.18% and 18.56% respectively. Patients with central obesity in urban and rural areas accounted for 83% and 91%, and the rate of patients with central obesity in urban was lower than that in countryside(p = 0.0022). 6 After adjusting for other factors, compared to rural,effect of blood pressure control was better in urban than in rural(OR = 1.571, 95% CI: 1.129- 2.187). Increasing BMI 1 kg/m2, the possibility of blood pressure control was decreased by 5.5%(OR = 0.945, 95% CI: 0.903 0.989). Salt intake more patients Compared with taste partial light/normal patients", Salt intake more patients made the difficulty of blood pressure control increased by 43.3%(OR = 0.567, 95% CI: 0.381 0.846). Increasing Food diversification score(DDS) 1 minute, the possibility of blood pressure control was increased by 9.7%(OR = 1.097, 95% CI: 1.007 1.194).Conclusion 1 The patients’ control level of blood pressure is better than the national average, but there is still further room for improvement. 2 On the whole, blood pressure control level of hypertension in Huai’an has a gap between urban and rural areas, which indicates that in community management of chronic diseases, especially of hypertension patients, the education and management of hypertension patients in rural areas still should be strengthened. 3 To the local region, less salt intake, more bland diet, and getting enough exercise, can improve the effect of hypertension patients’ blood pressure control more significantly,. |
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