【作者】 张晓东；

【导师】 于海初；

【作者基本信息】 青岛大学 ， 内科学（心血管病）（专业学位）， 2021， 硕士

【摘要】 目的:探讨基于“高血压达标中心”管理模式针对高血压患者的血压控制效果、用药依从性以及生活质量等产生的影响。方法:选取2019年4月-2019年12月期间就诊于青岛大学附属医院医疗集团的307例高血压患者作为试验组,267例高血压患者作为对照组,并实施前瞻性研究。试验组按照“高血压达标中心”管理模式及流程进行管理,对照组按常规慢病管理模式进行管理;试验组随访时间根据患者的病情每1～3个月随访1次,共随访6个月,对照组随访时间按照常规慢病管理模式,2次/6个月的频率进行随访,共随访6个月。比较两组患者经不同管理模式前后的血压控制效果、用药依从性评价(MMAS-8)、生活质量评价(SF-36)、抑郁评价(PHQ-9)和焦虑评价(GAD-7)的异同。统计学分析应用SPSS 26.0统计软件进行数据统计分析。计量资料采用均数±标准差((?)±s)描述,计数资料以百分率(%)表示。如果计量资料呈正态分布且方差齐,则执行t检验;如果计量资料与正态分布不符则执行秩和检验;计数资料执行x~2检验。P<0.05代表差异具备统计学意义。结果:两组患者分别经“高血压达标中心”管理模式和常规慢病管理模式管理6个月后,试验组血压控制率较对照组高(90.55%比53.93%,P<0.05),且试验组收缩压下降值较对照组高[(12.16±19.93)mm Hg比(4.42±19.66)mm Hg,P<0.05];管理6个月后试验组的用药依从性评分为7.09±1.06,对照组的评分为6.84±0.94,两组患者用药依从性均高于管理前,且试验组高于对照组(P<0.05);管理6个月之后试验组患者在生活质量评价(SF-36)当中的生理功能(PF)、总体健康(GH)、生理职能(RP)、精力(VT)、情感职能(RE)、社会功能(SF)以及精神健康评价(MH)七个条目评分都高于对照组,且差异具备统计学意义(P<0.05),躯体疼痛(BP)评分与对照组相比无统计学差异;管理6个月后,在抑郁评价(PHQ-9)评分中,试验组为7.21±4.77,对照组为7.76±4.53,两组患者抑郁评价评分较管理前均有下降,但试验组评分有更显著的降低,同时两组管理之后差异存在统计学意义(P<0.05);管理6个月后,焦虑评价(GAD-7)评分中,试验组与对照组分别为7.35±4.17、8.24±4.29,两组患者焦虑评价都与管理之前相比有所降低,其中试验组评分降低更具显著性,同时两组管理之后差异都存在统计学意义(P<0.05)。经多元线性回归分析示,“高血压达标中心”管理模式与收缩压变化显著相关,相关系数为-6.6(P<0.05)。管理6个月后,试验组患者的单片复方制剂(SPC)使用率为54.1%,而对照组患者的单片复方制剂使用率为32.2%,两组差别具有统计学意义(P<0.05)。结论:经过“高血压达标中心”管理模式管理后,高血压病人的血压控制效果明显,有效的提高了患者的用药依从性,改善患者的生活质量。更多还原

【Abstract】 Objective:Explore the impact of the"Hypertension Center"management model on the blood pressure control effect,medication adherence,and quality of life of hypertensive patients.Methods:Selected 307 hypertensive patients in the medical group of Qingdao University Affiliated Hospital from April 2019 to December 2019 as the experimental group and 267hypertensive patients as the control group,and implemented a prospective study.The experimental group was managed under the management mode and process of the"Hypertension Center",and the control group was managed under the conventional chronic disease management model.The follow-up time of the experimental group was based on the condition of the patients every 1～3 months for a total of 6 months.The follow-up time of the control group was under the conventional chronic disease management model,and the follow-up was conducted at a frequency of 2 times/6 months,for a total of 6 months.To compare the similarities and differences of the effectiveness of blood pressure control effect,medication adherence evaluation(8-item Morisky Medication Adherence,MMAS-8),quality of life evaluation(Short Form 36-item Health Survey,SF-36),depression evaluation(9-item Patient Health Questionnaire,PHQ-9),and anxiety evaluation(7-item Generalized Anxiety Disorder Questionnaire,GAD-7)in the two groups of patients before and after different modes of management.SPSS 26.0 statistical software was used for data statistical analysis.The measurement data was described by the mean±standard deviation((?)±s),and the counting data was expressed as a percentage(%).If the measurement data is normally distributed and the variances are uniform,the t-test is performed.If the measurement data does not match the normal distribution,the rank-sum test is performed.The count data was subjected to the x~2 test.P<0.05 means that the difference is statistically significant.Results:Two groups of patients were respectively managed by"Hypertension Center"management mode and general community chronic disease management mode for 6months.The blood pressure control rate of the experimental group was higher than that of the control group(90.55%vs.53.93%,P<0.05),and the systolic blood pressure drop value of the experimental group was higher than that of the control group[(12.16±19.93)mm Hg vs.(4.42±19.66)mm Hg,P<0.05].After 6 months of management,the medication adherence score of the experimental group was 7.09±1.06,and the score of the control group was 6.84±0.94.The medication adherence of the two groups of patients was higher than before management,and the experimental group was higher than the control group(P<0.05).After 6 months of management,the experimental group patients’physical function(PF),general health(GH),role-physical(RP),vitality(VT),role-emotional(RE),social functioning(SF),and mental health(MH)of quality of life evaluation were all higher than those of the control group,and the differences were statistically significant(P<0.05).The body pain(BP)score was not statistically different compared with the control group.After 6 months of management,in the depression evaluation,the score of the experimental group was 7.21±4.77 and that of the control group was 7.76±4.53.The scores of the two groups of patients decreased compared with before management,but the score of the experimental group decreased more significantly.After that,the difference between the two groups was statistically significant(P<0.05).After 6 months of management,in the anxiety evaluation,the scores of the experimental group and the control group were 7.35±4.17 and8.24±4.29,respectively.The anxiety evaluation scores of the two groups of patients were reduced compared with those before the management,and the score reduction of the experimental group was more significant.After that,the difference between the two groups was statistically significant(P<0.05).Multivariate linear regression analysis showed that the management model of"Hypertension Center"was significantly related to changes in systolic blood pressure,with a correlation coefficient of-6.6(P<0.05).After 6 months of management,the use rate of single-pill combination(SPC)in the experimental group was54.1%,while the use rate of SPC in the control group was 32.2%.The difference between the two groups was statistically significant(P<0.05).Conclusion:After the management of"Hypertension Center"management mode,the blood pressure control effect of hypertensive patients is obvious,which effectively improves the patient’s medication adherence and improves the quality of life of patients.更多还原