| Objective Implementing health management to the elderly hypertensive patients aged from 60 to 79 years old in Nanjing community,and evaluating the effect of hypertension health management by patients' health-related index,self-efficacy and quality of life of elderly hypertensive patients.Provide references for exploring the effective model of community elderly hypertension management,improving the self-efficacy and quality of life of elderly hypertensive patients,improving the health status of elderly people with hypertension,and government' s policies supporting for community elderly hypertensive health management.Methods In this study,a randomized controlled trial and cluster random sampling were conducted for 60 to 79 year-old patients with hypertension in a community health service center in Nanjing.After collecting the baseline questionnaire data,1000 elderly patients with hypertension at baseline were divided into management group and control group randomly,there were 500 people in management group and control group.Implementing 6-month health management intervention to the management group,when the control group without any intervention.After 6 months,elderly hypertensive patients of management group and control group were surveyed again.The baseline questionnaire included demographic characteristics and disease—related demographic characteristics,self-efficacy and quality of life of hypertension.To measure self-efficacy and quality of life of hypertension,we used self-efficacy scale,hypertension specific scale.Data were analyzed by SPSS18.0.Statistical methods included descriptive analysis,t test,chi-square test,one-way ANOVA,multiple linear regression,multilevel model.Results(1)In the questionnaire at baseline,the management group of elderly patients with hypertension was 500,while 500 elderly hypertensive patients in the control group.Health management period is 6 months.6 months later,after the completion of the health management,management group had 414 patients while 383 patients in control group.The follow-up loss ratio of management group and control group were 17.20%and 23.40%respectively.(2)By using variance analysis of single factor,t test,chi-square test and other statistical methods,to compare the health-related indicators of hypertension before and after 6-month health management among management group and control group respectively.Results showed that the elderly hypertensive patients' self-rated health score,hypertension-related knowledge score,diet score,BMI score,and systolic pressure have statistically significant differences between management group and control group(P<0.05),the performance of management group was better than control group.Using multiple linear regression analysis to analyze the influencing factors of the health indicators' changes related to elderly hypertension,results showed that:the educational background had significant influences on hypertension health knowledge score(P<0.05);statistically significant effect of gender and educational background on diet score(P<0.05).(3)Using self-efficacy scale to analyze elderly hypertensive patients' self-efficacy,results show that the difference of health behavior,medication,compliance behavior between the hypertension management group and the control group was not statistically significant at baseline.Before and after the management,the difference of the changes of daily life,health behavior,medication compliance behavior between the management group and control group was statistically significant by using DID model,every score of management group increased while score of the control group all decreased.Different gender,age,educational background,marital status,living conditions,health behaviors(smoking,drinking,exercise)had different effects on different dimensions of hypertension self-efficacy:elder patients with low education and a lot of daily exercise,whose score changed more than young patients with high education and less daily exercise in daily-life dimension,the difference was statistically significant(Age:F=3.729,P=0.024<0.05;Education:F=7.346,P=0.000<0.05;Daily Exercise Time:F=3.755,P=0.024<0.05);the difference of change value of medication dimension of self-efficacy among elderly hypertensive patients with different marital status was statistically significant(F=4.438,P=0.035<0.05);the elderly who exercise a lot everyday,whose score changed more in compliance behavior dimension of self-efficacy than those who exercise a little everyday,the difference was statistically significant(F=3.272,P=0.038<0.05).(4)Using hypertension specific scale of quality of life to analyze elderly hypertensive patients' quality of life,results show that the difference of physical function,psychological function,social function,hypertension specific function between the hypertension management group and the control group was not statistically significant at baseline.Before and after the management,the difference of the changes of physical function,hypertension specific function between the management group and control group was statistically significant by using DID model,the score of management group increased while score of the control group decreased.Different gender,age,educational background,marital status,living conditions,health behaviors(smoking,drinking,exercise)have different effects on different dimensions of hypertension quality of life:there were no significant differences in the scores of the quality of life of the elderly patients with different gender,age,smoking and drinking(All P>0.05);elderly with low education whose score improved more than those with high education in social function dimension,the difference was statistically significant(F=7.158,P=0.000<0.05);the elderly who' s married,not live alone and exercise a lot everyday improved more in compliance behavior dimension score of self--efficacy than those who' s not married,live alone and exercise a little everyday,the difference was statistically significant(Marital Condition:F-5.419,P=0.020<0.05;Living Condition:F=3.932,P=0.048<0.05;Daily Exercise Time:F=3.128,P=0.044<0.05).Using multilevel model to analyze elderly hypertensive patients' quality of life,results showed that:the quality of life score of elderly hypertensive patients varied differently in different group with the past of time,management group' s score increased while control group' s score decreased and management group' s score varied more.Conclusion It is the aim of health management to improve the life expectancy of the elderly patients with hypertension and reduce the physical and psychological harm of hypertension.The conclusion is summarized as:(1)The effect of health management project about managing elder hypertensive patients' health based on community is obvious.(2)Establishing a system of senile hypertension community health management,making policies supporting the health management of elderly hypertensive patients in community both can help to curb the growth of medical expenses,balance the contradiction between growing demand for health care and the limited medical resources. |
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