| 引用本文：唐文熙, 叶婷, 张亮.连续性服务路径下高血压控制效果评价——一项农村社区干预实验[J].中国卫生政策研究,2016,9(7):15-22 |
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| 连续性服务路径下高血压控制效果评价——一项农村社区干预实验 |
| 投稿时间：2015-11-16 修订日期：2016-02-25 PDF全文浏览 HTML全文浏览 |
| 唐文熙1, 叶婷2,3, 张亮2,3 |
1. 中国药科大学国际医药商学院 江苏南京 211198;
2. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030;
3. 湖北省农村健康服务研究中心 湖北省人文社科重点研究基地 湖北武汉 430030 |
| 摘要:目的：为提高农村地区高血压人群血压控制率，设计连续性服务路径干预方案，通过现场干预和人群对照研究，论证方案有效性，并探索其他影响因素。 方法：连续性服务路径包括连续性社区保健路径、临床诊疗路径和综合管理路径。2012年7月-2014年6月，选取重庆黔江4乡镇分为2组进行干预，分层随机抽样患者进行对照。采取双重差分模型对血压值和血压控制率进行分析。结果：853名患者接受基线调查，最终随访712人。经检验，乡镇和患者因素不构成干扰，组间血压值具有可比性。相比对照组，实验组血压值下降10.156 mmHg（P<0.001），血压控制率上升27.6%（P<0.001）。家庭结构、教育水平和到医疗机构的距离对血压值的降低有显著影响。结论：连续性服务路径有利于降低血压值，提高血压控制率；其中血压控制率变化更敏感。建议通过增加患者社会支持、强化慢病健康教育、改善公共交通服务，进一步提高农村高血压患者慢病管理效果。 |
| 关键词:连续性服务 血压控制率 社区干预 农村 |
| 基金项目:中华医学基金会资助项目（11-069）；江苏省高校哲学社会科学基金（2016SJD63007） |
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| The effect evaluation of continuous care pathway on hypertension control: Evidence from a rural community-based quasi-experiment |
| TANG Wen-xi1, YE Ting2,3, ZHANG Liang2,3 |
1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China;
2. School of Social Medicine and Health Management, Huazhong University of Science and Technology, Wuhan Hubei 430030, China;
3. Research Center of Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province Department of Education, Wuhan Hubei 430030, China |
| Abstract:Objectives: To test the effect of continuous care on rural hypertension control, we developed a comprehensive intervention strategy and implemented a community-based quasi-experiment in Southwestern rural China. Methods: The intervention took place in Qianjiang District, Chongqing Municipality from July 2012 to June 2014. 4 towns were randomly selected and categorized into 2 groups based on a comprehensive consideration of population and social development level. All the rural hypertension patients in treatment group were intervened with the Multi-institutional Continuous Pathway which was consisted of three parts: the Continuous Primary-Care Pathway, the Continuous Clinical Pathway and the Continuous Management Pathway. The patients in the control group served as a blank comparison using the usual care. Difference-in-differences Model was used to test the effect of blood pressure control in treatment group. Results: 853 patients were sampled and investigated using the stratified randomly sampling strategy and 712 of them had been followed up by the end of this program. The potential bias of pilot and patient selection were eliminated through control before and after the intervention. The previous blood pressure trends showed no statistically significant difference between groups. The systolic blood pressure in treatment group declined by 10.156 mmHg (P<0.001) compared to control group after intervention, and the blood pressure control rate had increased by 27.6% (P<0.001). Other contributing factors besides intervention were family structure, education level and medical service availability. Conclusion: The continuous care pathway have a significant marginal positive effect on hypertension control besides the national compulsory primary care, and the control rate change of blood pressure is more sensitive compared to blood pressure change. The potential contributing factors show that other intervention strategies could be developed to improve the rural hypertension control by adding to the social capital of rural patient, reinforcing the health education and facilitating the village transportation. |
| Key words:Continuous care Control rate of blood pressure Community-based quasi-experiment Rural area |
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