Study On The Community Health Management Service Of Elderly Patients With Hypertension In Lu'an City Based On Prevention And Treatment Effectiveness

Objective: To study the current status of health management of elderly patients with hypertension in Lu'an City by investigating the indicators of hypertension prevention and control such as prevalence rate,awareness rate,treatment rate and control rate,and community hypertension management service,and exploring their relevant influencing factors.In doing so,a suggestion on local hypertension management will be provided.Methods: Questionnaires and physical examinations were conducted for the elderly aged 60 and over in a urban and a rural community located in Lu'an City.The survey included general demographic characteristics,behaviors and lifestyles,and different health conditions.Prevalence rate,awareness rate,treatment rate,awareness treatment rate,control rate and treatment control rate of hypertension were calculated.We also analyzed the influencing factors of the above rates.Meanwhile interview questionnaire was designed to interview the medical personnel responsible for hypertension management,including funding and standard management rate,implementation measures and characteristics,advantages and disadvantages.The interview data was summarized.Results: A total of 1029 elderly people with an average age of 71.75±6.40 years were surveyed including 460 in the city and 569 in rural areas.There were 467 males and 562 females.The prevalence of hypertension was 65.0%(standardization rate64.2%),the awareness rate was 68.9%(standardization rate 68.7%),the treatment rate was 43.6%(standardization rate 42.4%),and the treatment rate was 63.3%(standardization rate 61.7%),the control rate was 17.2%(standardization rate 17.2%),and the treatment control rate was 39.5%(standardization rate 41.1%).The results of multivariate logistic regression analysis were summaried as follows.Female [OR(95%CI): 0.600(0.453~0.796)],age [70~79 years old: 1.462(1.091~1.960),? 80 years old:2.704(1.703~4.295)],other occupations [0.459(0.266~0.792)],family history of hypertension[1.671(1.246 ~ 2.240)],obesity [BMI:1.917(1.193~3.083)],central obesity[waist to hip ratio:1.710(1.231~2.374)] and hypertriglyceridemia[1.503(1.035~2.182)] were factors influencing the prevalence of hypertension.Living in city [OR(95% CI): 4.447(2.641~7.489)],more than middle income[0.364(0.170~0.778)],family history of hypertension [2.607(1.745~3.896)] and central obesity [waist to hip ratio:1.999(1.366~2.924)] were factors influencing the awareness rate of hypertension.Living in city [OR(95% CI): 8.626(5.575~13.346)],family history of hypertension [1.698(1.140~2.531)],physical exercise [2.491(1.552~3.997)]were factors influencing the treatment of patients.Living in city [OR(95% CI): 6.647(3.344~13.213)],commercial and service personnel [3.653(1.218~10.962)],production and transportation personnel [4.202(1.275~13.845)],physical exercise[2.524(1.329~4.792)] were factors influencing the patient's awareness of the treatment rate.Living separately [OR(95% CI): 0.534(0.309~0.924)],having pension [4.331(1.578~11.888)],having other major economic sources [7.887(1.519~40.954)],taking medicine unregularly [188.368(31.650~1121.079)] and taking medicine regularly[115.179(26.030~509.657)] were factors influencing the blood pressure control of patients.Living in city [OR(95% CI): 14.145(8.865~22.570)] was a protective factor affecting the patient's treatment control rate.In addition,there are still some problems in the community health management service of hypertension needed to be solved,including poor support of hypertension prevention and control from the government and society,the health management personnel of hypertension being insufficient,poor communication effect and the management effect of blood pressure control in the elderly needs to be improved.Conclusion: The prevalence,awareness rate,treatment rate,awareness treatment rate,control rate and treatment control rate of hypertension in the elderly in Lu'an Cityare higer than the national average levels.The prevalence is higher than that of developed countries and regions.But awareness rate,treatment rate,awareness of treatment rate,control rate,and treatment control rate are lower.In addition,there are many other problems in the health management service of hypertension in the community.So Lu'an City should learn from the "hospital-community-family" hypertension health management model by defining the division of labor clearly,performing their duties in the health management of hypertension.In particular,the community should focus on elderly patients living in rural areas with low income,no physical exercise and family history of hypertension by providing active hypertension health management services treatment.The government and relevant departments should increase management investment in hypertensive patients,strengthen investment in community fitness facilities,actively create healthy communities,standardize clinical pathways for hypertension treatment,unify prescriptions,and develop some simple,easy-to-learn and easy for grassroots application measures in the treatment of hypertension.