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目的:探索符合深圳市社区劳务工高血压患者管理模式。方法:通过现场研究探索建立“社区首诊、团队服务、首诊医师负责以及双向转诊”的劳务工高血压患者健康管理模式;通过日常工作记录资料的收集及调查问卷,对社区劳务工高血压患者管理模式实施前后的效果进行评价。结果:实施专案管理组的患者药物依从性(90.32%)、血压控制良好率(86.9%)及总体满意度(98.92%)都要明显高于对照组。结论:劳务工高血压患者管理模式的实施对提高高血压筛查数量、管理数量、改善患者的就医行为及提高血压控制率起到了很好的效果。
Objective: To explore in line with Shenzhen community labor hypertensive management pattern. Methods: Through the field research, we found out the mode of health management for labor-induced hypertensive patients with “first community consultation, team service, first-aid physician’s responsibility and two-way referral”. Through the daily work record collection and questionnaire, Hypertensive patients management model before and after the implementation of the evaluation. Results: The compliance rate (90.32%), good rate of blood pressure control (86.9%) and overall satisfaction (98.92%) in the project management group were significantly higher than those in the control group. Conclusion: The implementation of labor-intensive hypertension patients management mode has a good effect on increasing the number of hypertension screening, managing the quantity, improving the patient’s medical treatment and raising the blood pressure control rate.