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目的探讨和建立有效降低北京崇文社区脑卒中发病、死亡及危险因素水平的长效机制与模式。方法选择有良好人群基础的崇文社区,建立以区卫生局领衔,下属3所医院为技术平台的社区人群脑卒中防治体系。培训社区医务人员和街道干部,创建慢性病与公共卫生相结合的基础队伍。在社区人群中开展危险因素水平的调查与评估,对高危人群进行综合性干预及全人群健康教育与促进。结果对1016例心脑血管病患者治疗依从性分析显示,男性和女性患者症状改善而自行停药者分别占35．5%和30．3%,每日坚持规律服药者分别占62．8%和69．6%;影响药物治疗的9项因素中,忘记服药、医疗费用高、家庭经济原因均＞20．0%,因药物产生不适反应而停药的男性和女性仅为17．8%和11．3%,女性遵守医嘱的依从性高于男性。经常进行体育锻炼的居民由基线调查时的53．9%上升到66．4%。从2004年、2003年脑卒中发病率、死亡率观测社区干预初见效果。结论在我国城市脑卒中高危人群中开展大规模、系统的社区综合性干预,群体健康教育与促进,可有效控制社区人群危险因素水平,对降低脑卒中发病率、死亡率有着重要意义。基层医院保健科医生经过系统慢性病防治培训,可承担起社区脑卒中综合性预防的基本职能,为我国社区公共卫生战略实施提供可操作性模式。
Objective To explore and establish a long-term mechanism and mode of effectively reducing stroke morbidity, mortality and risk factors in Beijing Chongwen community. Methods The Chongwen community, which had a good population basis, was established and a stroke prevention and control system was set up for the community population led by the District Health Bureau and the three affiliated hospitals. Train community health workers and street leaders to create a basic team that combines chronic diseases with public health. In the community of people to carry out risk factors in the survey and evaluation of high-risk groups for comprehensive intervention and the whole population health education and promotion. The results of 1016 patients with cardiovascular and cerebrovascular disease compliance analysis showed that male and female patients with symptoms and their own withdrawal were accounted for 35.5% and 30.3%, daily adherence to regular medication were accounted for 62.8% And 69.6% respectively. Of the 9 factors that affected the drug treatment, those who forgot to take the medicine, the medical expenses were high, and the economic reason of the family was> 20.0%. Only 17.8% of the men and women discontinued due to the drug’s unpleasant reaction, And 11.3%, women comply with doctor’s orders compliance than men. The number of residents exercising regularly increased from 53.9% at the baseline survey to 66.4%. From 2004, 2003 incidence of stroke, mortality observed community intervention initial effect. Conclusion It is of great significance to carry out large-scale and systematic community-based interventions, group health education and promotion among the high-risk groups of stroke in urban areas in our country to effectively control the risk factors of community population and to reduce the incidence and mortality of stroke. Primary health care physicians through the system of chronic disease prevention and treatment training, can take the community a comprehensive prevention of basic functions of stroke, community health strategy implementation for our community to provide an operational mode.