| ObjectiveTo study the effect of core comprehensive interventions based on self-management support on blood pressure control and its influencing factors in elderly patients with poorly controlled hypertension,with a view to selecting and optimizing the comprehensive prevention and treatment strategies for blood pressure control and health management of elderly hypertensive patients in the community,saving hygiene Resources,improve patient self-management ability and blood pressure control effect to provide scientific reference basis.Method1 Network meta-analysis of randomized controlled studies on the intervention effects of different self-management support modelsIn 4 English databases including Pubmed database and Cochrane Library,and 3Chinese databases including CNKI and Wanfang Data,collected literature data on the impact of self-management support interventions on blood pressure of patients with hypertension published from 2010 to 2019.The ranking of results is expressed by SUCRA score,and publication bias analysis is performed.2 A randomized controlled study of the effect of core comprehensive interventions based on self-management support on blood pressure control in elderly patients with poorly controlled hypertension in the communityA total of 220 research subjects were recruited based on on-site publicity and mobilization based on hypertensive patients 65 years of age and older who were on file in a community health service center in Fuzhou City,and based on the principle of voluntary participation.The research subjects were divided by the computer random number table method.Randomly divided into an intervention group and a control group,to carry out a randomized controlled study of the effect of core comprehensive intervention on blood pressure control in elderly patients with poorly controlled hypertension based on self-management support.First,on the basis of preliminary research,determine the core intervention content,namely low-salt diet,walking exercise,adherence to medication,etc.;then,conduct on-site teaching,on-site consultation and guidance,distribution of relevant knowledge and core content of self-management materials,telephone follow-up,etc.Self-management support for the intervention group,conduct self-management behavior guidance and follow-up twice a month for a period of 1 year.3 Analysis of influencing factors of self-management support core comprehensive intervention effectBased on the above randomized controlled study,a questionnaire survey of blood pressure control status and other relevant information,self-management behavior and ability of all intervention groups and control groups was conducted before and after the intervention,and the relationship between self-management behavior and blood pressure control effect was compared and analyzed.Its influencing factors.In the above analysis,the count data used Fisher exact probability method,the measurement data used the rank sum test(Wilcoxon signed rank test or Mann-Whitney U test),and the blood pressure fluctuations of patients were compared by two-factor repeated measurement analysis of variance.The analysis of the influencing factors of blood pressure control effect adopts single factor and multivariate Logistic regression.Result1 Network Meta analysis(1)According to the search strategy,3186 documents were initially found,and through strict screening,a total of 11 documents with self-management support from hospitals,families,communities and peers were finally included,with a total of 2351patients;(2)The results of the network meta-analysis showed that the effect of different self-management support modes on patients’ blood pressure control in descending order is: hospital>family>community>companion;(3)The hospital is most likely to be the subject of the best intervention for patient blood pressure control.Its SUCRA score for systolic blood pressure control is 95.4%,and the SUCRA score for diastolic blood pressure control is 88.9%;(3)There is no publication bias in the included literature.2 Randomized controlled studyAt baseline,there was no statistical difference between the core comprehensive management group and the control group in general information and disease-related characteristics(P>0.05);at the same time,there was no statistical difference in the scores of the two groups of subjects in terms of self-management behavior and self-efficacy.(P>0.05),the two groups of research subjects are comparable.(1)Comparison of blood pressure control effectsAfter 1 year of follow-up,the systolic blood pressure of the control group and the intervention group were 142(IQR: 135-148)mm Hg and 138(IQR: 134-145)mm Hg,respectively.The systolic blood pressure of the two groups decreased compared with the baseline,and the difference was both It is statistically significant(P<0.05).Compared with the control group,the intervention group had a greater decrease in systolic blood pressure,and the difference was also statistically significant(P<0.05).In terms of diastolic blood pressure,the diastolic blood pressure at the outcome of the intervention group was 82(IQR: 76-85)mm Hg,which was not statistically different from baseline(P>0.05);the diastolic blood pressure at the outcome of the control group was 82(IQR:78).-86)mm Hg,higher than the baseline,the difference was statistically significant(P<0.05).(2)Comparison of blood pressure control rateThe blood pressure control rate of the intervention group was significantly higher than that of the control group(54.7% VS 30.4%).Among them,the systolic blood pressure control rate of the intervention group was 61.1%,which was significantly higher than 35.4% of the control group,and the difference was statistically significant(P<0.05).However,there was no significant difference in the diastolic blood pressure control rate between the two groups(87.4% VS 79.8%).(3)Blood pressure fluctuation during follow-upThe systolic blood pressure of the intervention group gradually decreased during the 4 months before the follow-up and then remained stable;while the systolic blood pressure of the control group showed a relatively obvious downward trend within the 2months before the follow-up,but there were always fluctuations and even an upward trend.The results of two-factor repeated measures analysis of variance showed that there was an interaction between intervention measures and time(P<0.05).During the follow-up period,the diastolic blood pressure of the intervention group remained stable,and there was no obvious trend;while the control group showed a significant increase at the 6th month of follow-up and then dropped sharply,with large fluctuations.The results of two-factor repeated measures analysis of variance showed that there also was an interaction between intervention measures and time(P<0.05).3 Analysis of influencing factors of blood pressure control effect(1)Changes in self-management behavior and self-efficacy scoresThe scores of the intervention group and the control group in communication with doctors,work and rest,emotional management and self-efficacy were significantly higher than those at baseline,and the differences were statistically significant(P<0.05).Compared with the control group,the intervention group’s scores on work and rest,emotional management,and self-efficacy improved even more(P<0.05).In terms of communication with doctors,although there was no statistical difference in the increase in scores between the intervention group and the control group,the behavior improvement rate of the intervention group was higher(80.0% VS 57.0),and the difference was statistically significant(P<0.05).(2)Research on influencing factors of blood pressure control effectMultivariate logistic regression analysis showed that drinking is a risk factor for poor blood pressure control.The risk of poor blood pressure control for drinkers is4.448 times that of non-drinkers(P<0.05);communication with doctors is a protective factor for good blood pressure control.The risk of poor blood pressure control of patients who communicated was 0.417 times that of those who did not communicate with doctors(P<0.05).Conclusion(1)Comprehensive core interventions supported by self-management have apositive effect on improving blood pressure and increasing blood pressure control rate in elderly patients with poorly controlled hypertension;(2)The comprehensive core intervention of self-management support can improve the three dimensions of communication with doctors,work and rest,and e motional management,as well as the self-efficacy of patients;(3)Drinking is a risk factor for blood pressure control in elderly patients with poorly controlled hypertension,and communication with doctors is a protective factor for blood pressure control. |
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