CAJ | 학술논문

对社区劳务工高血压患者实施“社区首诊、团队服务、首诊医师负责以及双向转诊”的健康管理模式,建立专案管理且超过6个月的患者为管理组,未进行专案管理但在本中心登记超过6个月的患者列为对照组.实施管理后,劳务工高血压患者新增筛查数量从2008年的32例增加到2010年的701例,新增管理数量从7例增加到348例.对464例患者进行问卷调查,其中管理组196例(回收186份),对照组268例(回收248份),显示管理组药物依从性好的占90.3％ (168/186),明显高于对照组(26.6％,66/248,P=0.00)；血压控制满意率(87.1％,162/186)明显高于对照组(25.8％,64/248,P=0.00)；患者对社区卫生服务中心总体满意度为98.9％,明显高于对照组(88.7％,P=0.00).提示,劳务工高血压患者管理模式的实施对提高高血压筛查、管理数量,改善患者就医行为及提高血压控制率起到了很好的作用.
대사구노무공고혈압환자실시“사구수진、단대복무、수진의사부책이급쌍향전진”적건강관리모식,건립전안관리차초과6개월적환자위관리조,미진행전안관리단재본중심등기초과6개월적환자렬위대조조.실시관리후,노무공고혈압환자신증사사수량종2008년적32례증가도2010년적701례,신증관리수량종7례증가도348례.대464례환자진행문권조사,기중관리조196례(회수186빈),대조조268례(회수248빈),현시관리조약물의종성호적점90.3％ (168/186),명현고우대조조(26.6％,66/248,P=0.00)；혈압공제만의솔(87.1％,162/186)명현고우대조조(25.8％,64/248,P=0.00)；환자대사구위생복무중심총체만의도위98.9％,명현고우대조조(88.7％,P=0.00).제시,노무공고혈압환자관리모식적실시대제고고혈압사사、관리수량,개선환자취의행위급제고혈압공제솔기도료흔호적작용.
The management model “primary care in community,team service,first contact physician responsibility and two-way referral” was implemented for migrant workers with hypertension in the community.The hypertensive patients under the management for over six months were assigned as management group; the patients who were registered but not under management for over six months served as the control group.The number of new cases detected in hypertension screening increased from 32 in 2008 to 701cases in 2010; and number of hypertensive patients under management increased from 7 cases to 348 accordingly.A questionnaire survey was conducted in 464 hypertensive patients,including 196 cases in management group and 268 cases in control group with a response rate of 94.9％ (186/196) and 92.5％ (248/268) respectively.The results showed that drug compliance rate in management group (168/186,90.3％ ) was significantly higher than that in the control group ( 26.6％,66/248,P =0.00 ).The rate of blood pressure control in management group (87.1％,162/186 ) was significantly higher than that in the control group (25.8％,64/248,P =0.00).The overall satisfaction (98.9％) in management group was significantly higher than that in the control group (88.7％,P =0.00 ).The results indicate that implementation of the hypertension management in migrant workers improves the health seeking behavior and blood pressure control of patients.