基于慢性病一体化门诊的高血压病数智化医防融合管理效果分析

马程乘; 章炜颖; 刘仕俊; 李波; 叶旭辉

doi:10.16766/j.cnki.issn.1674-4152.003640

基于慢性病一体化门诊的高血压病数智化医防融合管理效果分析

doi: 10.16766/j.cnki.issn.1674-4152.003640

1.
杭州市上城区凯旋街道社区卫生服务中心全科, 浙江杭州 310016
2.
杭州市疾病预防控制中心慢性病防治所，浙江杭州 310000
3.
杭州市卫生健康委基层卫生处，浙江杭州 310000
4.
阿里云计算有限公司，浙江杭州 310010

基金项目:

浙江省卫生健康科技计划项目 2022KY1056

中国社区卫生协会“社区卫生科研基金”项目 202139

杭州市卫生科技计划重点项目 ZD20210031

详细信息

通讯作者:
马程乘, E-mail: yangfh1982@163.com

中图分类号: R197.61 R544.1
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出版历程
- 收稿日期: 2023-12-03
- 网络出版日期: 2024-11-19

Analysis of the effectiveness of digitized management in integrated medical and preventive care for hypertension through chronic diseases outpatient services

1.
Department of General Practice, Kaixuan Subdistrict Community Healthcare Center, Hangzhou, Zhejiang 310016, China

摘要

摘要: 目的分析基于慢性病一体化门诊的高血压病数智化医防融合管理的效果，为基层高血压病管理提供参考。方法 2021年9月选取凯旋街道社区卫生服务中心门诊中年龄为35~79岁的高血压患者772例，按随机数字表法分为干预组(388例)和对照组(384例)。干预组采用基于慢性病一体化门诊的数智化医防融合管理，对照组采用基于全科门诊的常规社区管理。干预18个月后统计分析2组患者干预前后生活方式的变化，血压和血压血糖血脂联合达标率的变化，以及研究终点时血压达标的影响因素。结果干预后干预组的饮酒[18.8%(73例)]、肥胖[5.4%(21例)]、腹型肥胖率[31.2%(121例)]改善，与对照组[27.1%(104例)、11.7%(45例)、45.1%(173例)]比较，差异均有统计学意义(χ²=7.468、19.627、15.738，P < 0.05)；干预组的血压和血压血糖血脂联合达标率[61.9%(240例)、53.4%(207例)]均高于对照组[44.3%(170例)、28.1%(108例)]，差异有统计学意义(χ²=23.964、50.843，P < 0.05)；多因素logistic回归分析显示，接受数智化医防融合管理(OR=1.587，95% CI：1.161~2.171)、血糖达标(OR=2.056，95% CI：1.294~3.266)、血脂达标(OR=1.490，95% CI：1.042~2.131)均是血压达标的独立促进因素(P < 0.05)。结论基于慢性病一体化门诊的数智化医防融合管理有助于提高高血压病的管理效果。
- 高血压病 /
- 数字化 /
- 智慧管理 /
- 医防融合
Abstract: Objective To enhance hypertension management in primary medical institutions by analyzing the effectiveness of digitized management of medical-preventive integration for hypertension based on integrated outpatient services for chronic diseases. Methods In September 2021, 772 hypertensive patients aged 35-79 were selected from the outpatient department of Kaixuan Subdistrict Community Healthcare Center. According to the random principle, 388 cases were assigned to the intervention group and 384 to the control group. The intervention group adopted digitized management of medical-preventive integration based on integrated outpatient services for chronic diseases, while the control group adopted a routine community hypertension management based on general outpatient services. After 18 months of intervention, statistical analysis assessed changes in lifestyle, blood pressure compliance rate, and combined compliance rats for blood pressure, blood glucose, and lipid levels in both groups before and after intervention. Factors influencing blood pressure compliance at the study endpoint were also analyzed. Results Following the intervention, the alcohol consumption, obesity, and abdominal obesity rates in the intervention group were improved [18.8% (73 cases) vs. 27.1% (104 cases), 5.4% (21 cases) vs. 11.7% (45 cases), 31.2% (121 cases) vs. 45.1% (173 cases), respectively], which were statistically significant compared to the control group (χ²=7.468, 19.627, 15.738, P < 0.05). The blood pressure compliance rate and the combined compliance rate of blood pressure, blood glucose, and lipid in the intervention group [61.9% (240 cases) and 53.4% (207 cases), respectively] were higher than those in the control group [44.3% (170 cases) and 28.1% (108 cases), respectively], with statistically significant (χ²=23.964, 50.843, P < 0.05). Multivariate logistic regression analysis showed that receiving digital integrated medical and preventive management (OR=1.587, 95% CI: 1.161-2.171), blood glucose control (OR=2.056, 95% CI: 1.294-3.266), and blood lipid control (OR=1.490, 95% CI: 1.042-2.131) were independent promoting factors for blood pressure control (P < 0.05). Conclusion The digitized management of medical-preventive integration based on integrated chronic disease outpatient services can improve the effectiveness of blood pressure disease management.
- Hypertension /
- Digitization /
- Intelligent management /
- Medical and preventive integration

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图 1 2组高血压病患者管理方法的主要差异

Figure 1. Main differences in management methods between the two groups of hypertensive patients

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表 1 2组高血压病患者基线资料比较[例(%)]

Table 1. Comparison of baseline data between the two groups of hypertensive patients [cases (%)]

组别	例数	性别		年龄			病史
组别	例数	男性	女性	35岁~	50岁~	65岁~	高血压	糖尿病	高脂血症
对照组	384	176(45.8)	208(54.2)	68(17.7)	202(52.6)	114(29.7)	288(75.0)	63(16.4)	143(37.2)
干预组	388	187(48.2)	201(51.8)	77(19.8)	187(48.2)	124(32.0)	289(74.5)	66(17.0)	146(37.6)
统计量		0.432^a		-0.096^b			0.027^a	0.051^a	0.012^a
P值		0.511		0.923			0.869	0.822	0.911
注：^a为χ²值，^b为Z值。

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表 2 2组高血压病患者干预前后血压及其他代谢指标水平比较(x±s)

Table 2. Comparison of blood pressure and other metabolic indicators levels between the two groups of hypertensive patients before and after intervention (x±s)

组别	例数	收缩压(mmHg)			舒张压(mmHg)			BMI			WC(cm)
组别	例数	干预前	干预后		干预前	干预后		干预前	干预后		干预前	干预后
对照组	384	145.43±15.24	139.60±13.83^b		85.74±9.78	82.01±10.05^b		25.11±2.89	24.66±2.87^b		89.20±8.84	86.93±8.54^b
干预组	388	146.82±14.88	134.75±14.50^b		85.98±9.12	79.05±9.02^b		25.22±3.09	23.11±3.04^b		89.72±6.75	84.60±8.09^b
统计量		1.284^a	32.580^c		0.352^a	28.300^c		0.525^a	212.720^c		0.917^a	29.013^c
P值		0.199	< 0.001		0.725	< 0.001		0.600	< 0.001		0.359	< 0.001

组别	例数	FBG(mmol/L)				HBA1c(%)				LDL-C(mmol/L)
组别	例数	干预前		干预后		干预前	干预后			干预前		干预后
对照组	384	6.19±1.39		6.11±1.63		5.67±0.85	5.58±0.94^b			3.17±0.86		3.01±0.90^b
干预组	388	6.19±1.55		5.70±1.68^b		5.68±0.87	5.32±0.92^b			3.13±0.80		2.62±0.65^b
统计量		0.031^a		24.454^c		-0.071^a	34.117^c			0.578^a		62.816^c
P值		0.976		0.001		0.944	< 0.001			0.564		< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 3 2组高血压病患者干预前后生活方式及规律服降压药情况比较[例(%)]

Table 3. Comparison of lifestyle and regular antihypertensive medication rates between the two groups of hypertensive patients before and after intervention [cases (%)]

组别	例数	吸烟		饮酒		肥胖		腹型肥胖		规律服降血压药
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	384	64(16.7)	60(15.6)	112(29.2)	104(27.1)	54(14.1)	45(11.7)	205(53.4)	173(45.1)^b	251(65.4)	271(70.6)
干预组	388	70(18.0)	57(14.7)	116(29.9)	73(18.8)^a	64(16.5)	21(5.4)^a	226(58.2)	121(31.2)^a	251(64.7)	305(78.6)^a
χ²值		0.254	0.131	0.049	7.468	0.281	19.627	1.850	15.738	0.039	6.578
P值		0.614	0.717	0.824	0.006	0.596	< 0.001	0.174	< 0.001	0.844	0.010
注：与同组干预前比较，^aP < 0.01，^bP < 0.05。

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表 4 2组高血压病患者干预前后血压、血糖、血脂及各项联合达标率比较[例(%)]

Table 4. Comparison of blood pressure, blood glucose, blood lipid, and the combined compliance rate of all items before and after intervention between the two groups of hypertensive patients [cases (%)]

组别	例数	血压达标		血糖达标		血脂达标		血压血糖血脂联合达标
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	384	88(22.9)	170(44.3)^a	311(81.0)	315(82.0)	209(54.4)	247(64.3)^a	44(11.5)	108(28.1)^a
干预组	388	79(20.4)	240(61.9)^a	313(80.7)	349(89.9)^a	210(54.1)	325(83.8)^a	45(11.6)	207(53.4)^a
χ²值		0.744	23.964	0.013	10.054	0.007	37.997	0.004	50.843
P值		0.388	< 0.001	0.910	0.002	0.933	< 0.001	0.952	< 0.001
注：与同组干预前比较，^aP < 0.01。

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表 5 高血压病患者血压达标相关影响因素的logistic回归分析

Table 5. Logistic regression analysis of factors related to blood pressure compliance of hypertensive patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
接受数智化医防融合管理	0.462	0.160	8.371	0.004	1.587	1.161~2.171
男性	-0.595	0.188	10.010	0.002	0.551	0.381~0.797
年龄
50岁~	-0.089	0.224	0.158	0.691	0.915	0.588~1.420
65岁~	-0.354	0.235	2.257	0.133	0.702	0.443~1.114
吸烟	-0.307	0.251	1.494	0.222	0.736	0.450~1.203
饮酒	-0.955	0.216	19.598	< 0.001	0.385	0.252~0.587
BMI
超重	-0.150	0.166	0.813	0.367	0.861	0.622~1.192
肥胖	-0.994	0.307	10.484	0.001	0.370	0.203~0.676
血糖达标	0.721	0.236	9.316	0.002	2.056	1.294~3.266
血脂达标	0.399	0.182	4.777	0.029	1.490	1.042~2.131
注：BMI以正常为对照。

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