四川省高血压患者随访管理与血压控制情况关系研究  

Study on the relationship between follow-up management and blood pressure control in hypertensive patients in Sichuan Province

作　　者：喻瑞 谢嘉龙 唐雪薇 张雪莉 任晓晖 YU Rui;XIE Jia-long;TANG Xue-wei;ZHANG Xue-li;REN Xiao-hui(West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041 [2]四川省卫生健康信息中心/四川省医疗大数据中心

出　　处：《现代预防医学》2025年第3期508-512,共5页Modern Preventive Medicine

基　　金：四川省2023年卫生服务专项调查。

摘　　要：目的旨在探讨四川省高血压患者随访管理对血压控制的影响,以提高人群血压控制率。方法基于四川省第七次国家卫生服务调查数据,纳入3587名高血压患者。采用描述性统计分析患者的随访管理情况、人口学特征、生活行为及健康状况,结合多因素logistic回归模型探讨影响血压控制的随访管理因素。结果血压控制率为68.9%。在有效控制的患者中,按医嘱规律服药率为84.6%,随访频率≥4占比71.4%,签约家庭医生入户随访率为48.1%;未有效控制的患者中,按医嘱规律服药率为73.4%,随访频率≥4占比67.6%,签约家庭医生入户随访率为45.2%。多因素logistic回归分析显示,未按医嘱规律服药(OR=1.742,95%CI:1.453~2.089)、随访频率<4(OR=1.287,95%CI:1.057~1.567)和其他随访方式(OR=1.286,95%CI:1.092~1.516)对患者血压控制效果有显著的负面影响。结论对高血压的随访管理有利于血压控制,应该优化随访频率、提高药物依从性和增强签约医生与患者的互动。Objective To explore the impact of follow-up management on blood pressure control in hypertensive patients in Sichuan Province,so as to improve the blood pressure control rate in the population.Methods Based on the data of the Seventh National Health Service Survey in Sichuan province,3587 hypertensive patients were included.Descriptive statistical analysis was used to analyze the follow-up management situation,demographic characteristics,lifestyle behaviors and health status of patients.Combined with the multivariate logistic regression model,the follow-up management factors affecting blood pressure control were explored.Results The blood pressure control rate was 68.9%.Among the effectively controlled patients,the rate of taking medications regularly as prescribed was 84.6%,the proportion of those with a follow-up frequency of≥4 was 71.4%,and the rate of family doctor-signed home visits was 48.1%.Among the patients not effectively controlled,the rate of taking medications regularly as prescribed was 73.4%,the proportion of those with a follow-up frequency of≥4 was 67.6%,and the rate of family doctor-signed home visits was 45.2%.Multivariate Logistic regression analysis showed that not taking medications regularly as prescribed(OR=1.742,95%CI:1.453-2.089),a follow-up frequency of<4(OR=1.287,95%CI:1.057-1.567)and other follow-up methods(OR=1.286,95%CI:1.092-1.516)had significant negative impacts on the blood pressure control effect of patients.Conclusion Follow-up management of hypertension is beneficial to blood pressure control.The follow-up frequency should be optimized,drug compliance should be improved,and the interaction between the signed doctor and the patient should be enhanced.

关 键 词：高血压 血压控制 随访管理 第七次国家卫生服务调查 

分 类 号：R544.1[医药卫生—心血管疾病]