目的　探讨社区卫生服务与社区人群慢病综合防治结合的可行性。方法　将所管辖区分为干预组与对照组 ,采用前瞻性调查研究方法和队列对照研究方法。结果　干预组卫生知识知晓率 ,行为改变情况与对照组及自身前后比较差异有显著性 ,(P <0 0 1或P <0 0 5 )干预组高血压管理率由原来 30 6 4%上升至 98 93% ,血压在 149 90mmHg以下的控制率由原 16 16 %提高为 85 5 2 % ,规范服药率由原来 31 49%上升到 97 2 3% ,与对照组及自身前后比较差异有显著性 (P <0 0 1)。结论　 (1)利用社区卫生服务站进行社区人群慢病综合性管理与控制更符合成本效益原则 ;(2 )在社区居民中开展慢病的健康教育为经济有效的慢病预防方法 ;(3)社区卫生服务站固定的合作关系及新型的医患模式能提高人群慢病的管理率、控制率。 Objective To explore the feasibility of combining community health services with comprehensive chronic disease prevention in community populations. Methods The jurisdiction was divided into intervention group and control group, and prospective investigation method and cohort control research method were used. Results There was a significant difference in awareness rate and behavioral change of the health knowledge between the intervention group and the control group and before and after self-administration (P <0 01 or P <0 05). The hypertension management rate in the intervention group increased from 306% to 46%. 98 93%, the control rate of blood pressure below 149 90mmHg was increased from the original 16 16% to 85 5 2%, and the standard medication rate increased from 31 49% to 97 2 3%. There was a significant difference between the control group and its own before and after comparison. (P < 0 0 1). Conclusions (1) The use of community health service stations for the comprehensive management and control of chronic diseases in community groups is more in line with the cost-effectiveness principle; (2) Health education for chronic diseases among community residents is an economically effective method for the prevention of chronic diseases; (3) The fixed cooperative relations and new types of doctor-patient models in community health service stations can improve the management and control of chronic diseases.