崔金煌　顾苗苗　王静芳

【摘  要】目的：研究探討社区慢病管理对高血压患者规范用药的效果。方法：选择在青浦区金泽镇社区卫生服务中心登记建档的100例高血压患者（2017年1月～2018年10月）进行前瞻性研究，分组方法选择随机数字表法，随机分为2组各50例，对照组实施常规社区管理，观察组实施社区慢病管理，比较两组：①服药依从性;②自我护理能力评分;③血压指标。结果：①服药总依从率分别为94%（观察组）、78%（对照组），观察组较对照组更高（P<0.05）。②两组干预后的自我护理能力各维度评分均较干预前增高，而干预后观察组的各维度评分均较对照组更高，P均<0.05。③两组干预后的SBP、DBP均较干预前降低，而干预后观察组的SBP、DBP均较对照组更低，P均<0.05。结论：社区慢病管理可有效提高高血压患者的服药依从性和自护能力，有利于更好地控制其血压状况。

【关键词】高血压;社区慢病管理;护理;服药依从性

【中图分类号】R9      【文献标识码】A      【文章编号】1672-3783（2019）04-0120-02

Evaluation of the effect of community chronic disease management on standardized drug use in patients with hypertension

【Abstract】Objective：To study the effect of community chronic disease management on standardized medication for patients with hypertension.Methods：A prospective study was conducted in 100 hypertensive patients （January 2017 to October 2018） registered in the Community Health Service Center. The randomized digital table method was selected by group method and randomly divided into two groups of 50 patients. The control group implemented routine community management， and the observation group implemented community chronic disease management. The two groups were compared： 1 medication compliance; 2 self-care ability score; 3 blood pressure index. Results： The total adherence rate of medication was 94% （observation group） and 78% （control group）， respectively. The observation group was higher than the control group （P<0.05）. 2 The scores of self-care ability in each group were higher than those before intervention， and the scores of each dimension in the observation group were higher than those in the control group， P<0.05. The SBP and DBP of the two groups were lower than those before the intervention， and the SBP and DBP of the observation group were lower than those of the control group， P<0.05.Conclusion：Community chronic disease management can effectively improve the compliance and self-care ability of patients with hypertension， which is beneficial to better control their blood pressure.

【Key words】hypertension; community chronic disease management; nursing; medication compliance

高血压是我国常见的一种慢性病，其发病率较高，多发生于中老年人群，增加了中老年人群发生脑卒中、冠心病、糖尿病等疾病的发病风险，临床上主张对高血压患者的血压予以控制，但由于高血压的病程漫长，部分患者需终身服药，易出现服药依从性差这一问题，对其血压控制不利^[1-2]。社区卫生服务中心是高血压患者出院后的主要管理机构，如何做好社区高血压的健康管理是社区卫生服务中心亟待解决的重要问题。社区慢病管理是一种规范性的社区健康管理方法，近年来被逐渐应用于社区高血压管理中，本研究为探讨社区慢病管理对高血压患者的作用，针对在青浦区金泽镇社区卫生服务中心登记建档的100例高血压患者（2017年1月～2018年10月）进行前瞻性研究。……