Analysis Of Community Health Service Utilization In Elderly Patients With Hypertension In A Community Of Jinan

Objectives:By analyzing the electronic health records and physical examination information of elderly patients with hypertension in a community health service center(CHCs)in Jinan,to understand the utilization of community health service(CHS)by elderly patients with hypertension and its influencing factors,to further evaluate the effects of different CHS utilization on the health of elderly patients with hypertension,and to analyze the blood pressure,blood lipid management and its influencing factors of the subjects.Provide a basis for the center to improve the utilization of CHS for elderly hypertensive patients and strengthen the management of elderly hypertensive chronic diseases.Methods:The EHR data and physical examination information of elderly patients with hypertension who underwent physical examination in a community health service center in Jinan from January 1,2019 to October 31,2019 were collected to describe their demographic characteristics,information on chronic diseases and the number of visits for hypertension within one year from the date of physical examination.Univariate and multivariate regression analysis were used to analyze the factors affecting the availability of CHS,and the health effects of CHS on elderly patients with hypertension were compared between groups.Further statistical analysis of the CHCs on the subjects' blood pressure and blood lipids control and influencing factors.Results:1.The single factors affecting the utilization of community health services in elderly patients with hypertension included the type of permanent residence,nationality,medical payment method,family doctor's contract,whether or not to participate in the annual physical examination of the previous year,the number of complications,the course of hypertension,coronary heart disease,hypertension management years,hypertension family history.There were significant differences in the utilization of hypertension CHS in this population.Multivariate analysis showed that minority nationality(OR=3.205,P=0.049),contracted family doctor(OR=8.079,P<0.001),coronary heart disease(OR=1.949,P=0.004),hypertension management for more than 5 years(OR=2.759,P<0.001),family history of hypertension in both parents(OR=1.709,P=0.021)were independently positively correlated with high utilization of CHS(P<0.001).Compared with employees' medical insurance,residents' medical insurance(OR=0.247,P<0.001),out-of-pocket medical insurance(OR=0.129,P=0.011)and remote medical insurance(OR=0.053,P<0.001)were independently and negatively correlated with the high utilization of CHS.It is suggested that ethnic minorities,medical insurance for workers,contracted family doctors,coronary heart disease,hypertension management for more than 5 years and parents with hypertension are more likely to use community health services.2.The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the high CHS utilization group were significantly lower than those of the low CHS utilization group(P<0.05),and the reaching rate of the hypotensive target value<150/90mmHg was significantly higher than that of the low CHS utilization group.There was no significant difference in the control of blood lipids(including blood lipid indexes,the prevalence rate of dyslipidemia,the prevalence rate of metabolic syndrome and the standard rate of LDL-C)between the two groups,but in terms of medication,the group with high utilization of CHS had better compliance and higher combination rate of antihypertensive drugs,and was more inclined to choose ACEI/ARB,?-receptor blockers and CCB drugs.The utilization rates of compound preparations and drugs recommended by non-guidelines were significantly higher in the group with low utilization of CHS(P<0.05).In terms of preventive use,the utilization rates of antiplatelet drugs(42.6%),statins(25.0%)and proprietary Chinese medicines(55.4%)in the high CHS utilization group were significantly higher than those in the low CHS utilization group(10.9%,5.3%and 12.9%,respectively).3.When the blood pressure target value are<130/80mmHg?<140/80mmHg?<140/90mmHg and<150/90mmHg,the blood pressure target rate is 18.9%?33.5%?41.3%and 77%separately;The results of univariate analysis showed that coronary heart disease,history of coronary revascularization,resting heart rate,medication compliance,?-blockers,compound antihypertensive drugs,fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)had significant effects on blood pressure control.The results of multivariate logistics regression equation showed that with illiteracy group as reference,primary school(OR=2.302,P=0.007),junior middle school(OR=2.041,P=0.019),senior high school(OR=2.001,P=0.022)and university(OR=2.018,P=0.029),and with non-complication group as reference,2 types(OR=2.307,P=0.018)and 3 types(OR=4.206,P=0.048)were combined.Taking compound preparation(OR=3.151,P=0.001)was independently and positively correlated with blood pressure control.Resting heart rate>80 beats/min(OR=0.669,P=0.013)and fasting blood glucose(OR=0.903,P=0.011)were risk factors for achieving blood pressure control.4.Subjects' blood lipid control:(1)425 patients(36.4%)were complicated with dyslipidemia,including hypercholesterolemia(16.3%),hypertriglyceridemia(13.0%),hypertriglyceridemia(12.8%)and hypo-HDL-C(13.2%).Univariate analysis showed that sex,number of complications,resting heart rate,hyperglycemia and fatty liver were significantly correlated with dyslipidemia(P<0.05).The results of multivariate regression analysis showed that the risk factors of dyslipidemia were gender(OR=1.396,0.021),resting heart rate>80 times/min(OR=1.471,0.025),coronary heart disease(OR=1.510,P=0.049),hyperglycemia(OR=1.814,P<0.001)and fatty liver(OR=1.572,0.021).(2)480 patients(41.2%)were complicated with MS,and the most abnormal item was abdominal obesity(76.3%).The results of univariate analysis showed that there were significant differences in medical payment,family history of diabetes,bad eating habits,pulse rate,BMI,RHR,systolic blood pressure and fatty liver complicated with metabolic syndrome(P<0.05).The results of univariate analysis showed that there were significant differences in the effects of medical payment,family history of diabetes,bad eating habits(mainly meat,sugar and oil salt),pulse rate,BMI,resting heart rate,systolic blood pressure and fatty liver on metabolic syndrome.Multivariate regression analysis showed that total public expense(OR=8.569,P=0.021),family history of diabetes(OR=2.276,P=0.032),diabetes mellitus(OR=5.929,P<0.001),waist circumference(OR=1.162,P<0.001),fasting blood glucose(OR=1.450,P<0.001)and triglyceride(OR=9.360,P<0.001)were risk factors for metabolic syndrome.High density lipoprotein cholesterol(OR=0.292,P<0.001)is the protective cause of metabolic syndrome.(3)LDL-C control:among 1166 subjects,When the target value of lipid regulation are<1.8mmol/L?<2.6mmol/L?and<3.4mmol/L,the rate of reaching the target of LDL-C are 10.8%?35.7%and 65.7%separately.Among the three lipid reduction targets,the LDL-C attainment rate of males was significantly higher than that of females.When the lipid reduction target of<2.6mmol/L was,the higher the attainment rate was with the increase of age grade.As the target is<2.6mmol/L,the rate of patients with<1.8mmol(with ASCVD and diabetes)was significantly higher than that with<2.6mmol(simple elderly patients with hypertension)(P<0.001).The overall LDL-C standard rate of the subjects was 19.6%.The results of univariate analysis showed that gender,coronary heart disease,diabetes,stroke,FBG,SBP,TG,TC and HDL-C were significantly correlated.Multivariate logistics regression analysis showed that gender(OR=0.664,P=0.012),SBP(OR=0.691,P=0.048),coronary heart disease(OR=0.123,P<0.001),diabetes(OR=0.187,P<0.001),stroke(OR=0.122,P<0.001)and TC(OR=0.30,P<0.001)were independently negatively correlated with LDL-C.HDL-C(OR=24.204,P<0.001)and TG(OR=0.99,P<0.001)were independently positively correlated with LDL-C.Conclusion:1.Among the subjects,ethnic minorities,medical insurance for workers,contracted family doctors,coronary heart disease,hypertension management for more than 5 years and parents with hypertension were more likely to use community health services.2.Elderly patients with hypertension are the focus of prevention and control of chronic diseases in the community health service center.The patients with high utilization of CHS have achieved remarkable results in the control rate of blood pressure with 150/90mmHg as the standard value(81.1%),and the utilization rate of first-line antihypertensive drugs and the rate of drug combination are higher,but the control of blood lipids(including the prevalence rate of dyslipidemia,the prevalence rate of metabolic syndrome and the standard rate of LDL-C)and the promotion of healthy living habits still need to be improved.3.In this study,the rate of reaching the target value of 140/90mmHg in middle-aged and elderly patients with hypertension was 41.3%,and the rate of reaching the target was higher.Illiteracy,RHR>80 times/min,FBG were the risk factors for reaching the standard of blood pressure.Those who took compound preparations and combined with more than two kinds of complications(including coronary heart disease,stroke and diabetes)had a higher rate of blood pressure control.4.In this study,the prevalence rate of dyslipidemia in elderly patients with hypertension was higher,the prevalence rate of metabolic syndrome(MS)was higher,and the rate of reaching the standard of LDL-C was lower.The prevalence rates of central obesity,BMI and various dyslipidemia in female patients were significantly higher than those in male patients,while the attainment rate of LDL-C in female patients was significantly lower than that in male patients.When<2.6mmol/L was taken as the target value of LDL-C,the rate of reaching the target in patients with complications was significantly higher than that in elderly patients with hypertension.