Study On The Effect Of Family Doctor Contract Service On The Management Of Elderly Hypertensive Patients At The Primary Level In Xinfeng County

Objective:To study the effect of the family doctor contract service model on the management of elderly hypertensive patients at the grassroots level in Xinfeng County,compare it with the conventional treatment model,clarify the role played by the family doctor contract service model in the management of elderly hypertensive patients at the grassroots level in Xinfeng County.To study the influencing factors of elderly hypertension at the grassroots level and provide targeted suggestions for the management and control of elderly hypertension.Methods:A random sampling method was adopted to select 300 elderly hypertensive patients who met the screening criteria from the already established hypertension health management files of a township health center in Xinfeng County.Informed consent was obtained from the patients and an informed consent form was signed for this study.The SPSS random number table was used to divide the control and intervention groups,with 150 cases in each group.The control group adopted the conventional diagnosis and treatment health education method,i.e.,health education during the consultation process,and the intervention group adopted the implementation of the family doctor contract service model intervention.Patient data were collected,including patient name,gender,age,and contact information;disease-related data included sexual blood pressure value,body mass index(BMI weight/height~2),waist circumference,history of smoking,history of alcohol consumption,heart rate,fasting glucose,blood lipids,creatinine,urea nitrogen,weekly exercise frequency,duration of each exercise,duration of hypertension,family history of hypertension,history of diabetes-related diseases,history of cerebrovascular diseases,history of Comorbidities,medication use,etc.;the two groups were evaluated and analyzed at month 3 and month 6,respectively.Single-factor logistic and multi-factor logistic regression analyses were performed to explore the influencing factors associated with hypertension in the primary elderly in Xinfeng County.Results:1.The balanced results of baseline data in both groups showed no significant differences in age,height,weight,BMI,heart rate,glucose,creatinine,urea nitrogen,triglycerides,cholesterol,systolic blood pressure,and diastolic blood pressure(P>0.05).2.After implementing different interventions for 6 months,the statistical results of t-test or one-way ANOVA after the intervention showed that there was a statistically significant difference between the two groups in terms of systolic blood pressure,diastolic blood pressure,BMI,waist circumference decreased and exercise time increased(P<0.05).The level of decrease in blood pressure between the two groups was statistically different by the test of chi-square data,and the decrease was more significant in the intervention group than in the control group(P<0.05).3.After 6 months of intervention,the number of intervention group blood pressure met the standard in 82 cases(58.2%)and the number of non-standard in 59cases(41.8%);the number of control group met the standard in 58 cases(42.0%)and the number of non-standard in 87 cases(63.0%),with statistical difference(P<0.05).In the intervention group,32 cases(22.7%)were hospitalized due to hypertension complications and 109 cases(77.3%)were not hospitalized;in the control group,39cases(28.3%)of hospitalization due to hypertension complications and 99 cases(71.7%)of non-hospitalization in the control group,with no statistical difference between the two groups(P>0.05),but the number of hospitalization due to hypertension complications was less in the intervention group than in the control group.4.The results of multifactorial logistic regression showed that absolute neutrophil value,smoking,BMI,hemoglobin,irregular medication,and blood glucose were independent influencing factors of hypertension at the primary level in Xinfeng County.ROC curves were drawn using the above six risk predictors,and the area under the ROC curve AUC=0.690,P<0.001,95CI%=0.588-0.791,suggesting some discriminatory ability.Conclusion:1.Under the intervention of family doctor contracting mode,the lifestyle of grass-roots elderly hypertensive residents was further improved,and the management of smoking and alcohol consumption was strengthened and salt intake was reduced;the promotion of exercise among grass-roots elderly hypertensive residents also had positive significance in terms of weight reduction.2.Under the intervention of family doctor contracting mode,the blood pressure management effect of grass-roots elderly hypertensive residents was better than conventional health management,and the blood pressure attainment rate was higher after family doctor contracting intervention.3.With the intervention of the family doctor contracting model,the number of hospitalizations for hypertensive complications among elderly hypertensive residents at the grassroots level was reduced,which can reduce the financial and care burden of patients and is worth promoting among elderly hypertensive patients at the grassroots level.