CAJ | 학술논문

目的：探索群组看病模式对社区高血压患者自我管理的影响。方法经社区动员，以上海某街道4个居委2011年1月-2012年12月签约管理自愿参与并符合标准的183例高血压患者为研究对象，按整群随机分组方法分为干预组（92例）和对照组（91例）。干预组患者以群组看病模式进行管理，对照组患者接受常规高血压管理。采用高血压群组看病问卷调查干预前、干预后3个月患者自我管理改变情况。结果干预前干预组和对照组服药依从性及身体活动依从性分布情况比较，差异无统计学意义（ P>0.05）；干预后干预组服药依从性和身体活动依从性分布情况比较，差异有统计学意义（ P <0.05）。干预组干预后服药依从性和身体活动依从性均高于干预前（χ2=9.653、8.807，P<0.05）；而对照组干预前后服药依从性和身体活动依从性比较，差异无统计学意义（χ2=0.389、1.626，P>0.05）。干预后干预组症状管理得分、疾病共性得分、社会支持得分、信任与参加得分均高于对照组（ P<0.05）。干预组干预后症状管理得分、疾病共性得分、社会支持得分、信任与参加得分均高于干预前（ P<0.05）。对照组干预前后症状管理得分、疾病共性得分、社会支持得分、归属感得分、信任与参加得分、互惠得分比较，差异均无统计学意义（P>0.05）。干预后干预组健康自评得分低于对照组（P<0.05）。干预前干预组收缩压高于对照组（P<0.05）；而干预后两组比较，差异无统计学意义（ P>0.05）。对照组干预前后健康自评得分、收缩压、舒张压比较，差异均无统计学意义（P>0.05）；干预组干预后的健康自评得分、收缩压、舒张压均低于干预前（P<0.05）。干预组患者参与障碍的前3位因素分别为：是否有参与需求（40.2%）、时间和地点是否合理（39.1%）、家庭事务因素（32.6%）。结论高血压群组看病模式可以改善患者自我管理相关结局，并能提高患者满意度与参与意愿；进一步分析该模式的参与障碍和影响因素，有助于社区高血压患者的长效管理与可持续发展。目的：探索群組看病模式對社區高血壓患者自我管理的影響。方法經社區動員，以上海某街道4箇居委2011年1月-2012年12月籤約管理自願參與併符閤標準的183例高血壓患者為研究對象，按整群隨機分組方法分為榦預組（92例）和對照組（91例）。榦預組患者以群組看病模式進行管理，對照組患者接受常規高血壓管理。採用高血壓群組看病問捲調查榦預前、榦預後3箇月患者自我管理改變情況。結果榦預前榦預組和對照組服藥依從性及身體活動依從性分佈情況比較，差異無統計學意義（ P>0.05）；榦預後榦預組服藥依從性和身體活動依從性分佈情況比較，差異有統計學意義（ P <0.05）。榦預組榦預後服藥依從性和身體活動依從性均高于榦預前（χ2=9.653、8.807，P<0.05）；而對照組榦預前後服藥依從性和身體活動依從性比較，差異無統計學意義（χ2=0.389、1.626，P>0.05）。榦預後榦預組癥狀管理得分、疾病共性得分、社會支持得分、信任與參加得分均高于對照組（ P<0.05）。榦預組榦預後癥狀管理得分、疾病共性得分、社會支持得分、信任與參加得分均高于榦預前（ P<0.05）。對照組榦預前後癥狀管理得分、疾病共性得分、社會支持得分、歸屬感得分、信任與參加得分、互惠得分比較，差異均無統計學意義（P>0.05）。榦預後榦預組健康自評得分低于對照組（P<0.05）。榦預前榦預組收縮壓高于對照組（P<0.05）；而榦預後兩組比較，差異無統計學意義（ P>0.05）。對照組榦預前後健康自評得分、收縮壓、舒張壓比較，差異均無統計學意義（P>0.05）；榦預組榦預後的健康自評得分、收縮壓、舒張壓均低于榦預前（P<0.05）。榦預組患者參與障礙的前3位因素分彆為：是否有參與需求（40.2%）、時間和地點是否閤理（39.1%）、傢庭事務因素（32.6%）。結論高血壓群組看病模式可以改善患者自我管理相關結跼，併能提高患者滿意度與參與意願；進一步分析該模式的參與障礙和影響因素，有助于社區高血壓患者的長效管理與可持續髮展。
목적：탐색군조간병모식대사구고혈압환자자아관리적영향。방법경사구동원，이상해모가도4개거위2011년1월-2012년12월첨약관리자원삼여병부합표준적183례고혈압환자위연구대상，안정군수궤분조방법분위간예조（92례）화대조조（91례）。간예조환자이군조간병모식진행관리，대조조환자접수상규고혈압관리。채용고혈압군조간병문권조사간예전、간예후3개월환자자아관리개변정황。결과간예전간예조화대조조복약의종성급신체활동의종성분포정황비교，차이무통계학의의（ P>0.05）；간예후간예조복약의종성화신체활동의종성분포정황비교，차이유통계학의의（ P <0.05）。간예조간예후복약의종성화신체활동의종성균고우간예전（χ2=9.653、8.807，P<0.05）；이대조조간예전후복약의종성화신체활동의종성비교，차이무통계학의의（χ2=0.389、1.626，P>0.05）。간예후간예조증상관리득분、질병공성득분、사회지지득분、신임여삼가득분균고우대조조（ P<0.05）。간예조간예후증상관리득분、질병공성득분、사회지지득분、신임여삼가득분균고우간예전（ P<0.05）。대조조간예전후증상관리득분、질병공성득분、사회지지득분、귀속감득분、신임여삼가득분、호혜득분비교，차이균무통계학의의（P>0.05）。간예후간예조건강자평득분저우대조조（P<0.05）。간예전간예조수축압고우대조조（P<0.05）；이간예후량조비교，차이무통계학의의（ P>0.05）。대조조간예전후건강자평득분、수축압、서장압비교，차이균무통계학의의（P>0.05）；간예조간예후적건강자평득분、수축압、서장압균저우간예전（P<0.05）。간예조환자삼여장애적전3위인소분별위：시부유삼여수구（40.2%）、시간화지점시부합리（39.1%）、가정사무인소（32.6%）。결론고혈압군조간병모식가이개선환자자아관리상관결국，병능제고환자만의도여삼여의원；진일보분석해모식적삼여장애화영향인소，유조우사구고혈압환자적장효관리여가지속발전。
Objective To study the influence of group medical visits model on self-management on the hypertension patients. Methods From January 2011 to December 2012,183 hypertension patients meeting the inclusive standards were vol-untarily involved in the study from four neighborhoods in a community of Shanghai after community mobilization. Then the sub-jects were divided into intervention group(n=92)and control group(n=91)by random cluster sampling method. The patients in the intervention group were managed with procedure of the group visits,while the control group was accepted with conventional hypertension management. Both groups were investigated about their self-management change by group medical visits question-naire before intervention and 3 months after intervention. Results Before the intervention,the patients' distributions of medica-tion compliance and physical activity compliance in the intervention group and control group were no statistically significant( P>0. 05),but they were significant after intervention(P<0. 05). Patients' medication compliance and physical activity compli-ance in intervention group were higher after intervention than before intervention(χ2 =9. 653,8. 807,P<0. 05);they were no significantly different in control group(χ2 =0. 389,1. 626,P>0. 05). After intervention,symptom management,social sup-port self-efficacy,trust and participation had significant improvement in intervention group than those in control group( P <0. 05). They also had significant improvement in intervention group after intervention(P<0. 05),but no significant in control group and the differences of sense of belonging and reciprocity were no significant,too(P>0. 05). Self-rated health score was lower in intervention group than that in control group after intervention(P<0. 05). The systolic blood pressure was higher in in-tervention group than that in control group before intervention(P<0. 05),but after intervention,the difference was no signifi-cant(P>0. 05). Self-rated health score,systolic pressure and diastolic pressure in control group were no significant difference before and after intervention(P>0. 05)and they were all lower in intervention group after intervention with significant difference (P<0. 05). The first three factors influencing patients' participation were participation demands(40. 2%),suitable time and places for the activities(39. 1%),family affaires(32. 6%). Conclusion The group medical visits of hypertension can im-prove the related self-management outcome,and the satisfaction as well as participation willingness of the patients. Further a-nalysis of the participating barriers and influence factors contribute to the long-term and sustainable development of community hypertension management.