摘 要
高血压作为全球范围内常见的慢性疾病，其管理效果直接影响患者的生活质量和医疗负担。为探索更有效的管理模式，本研究旨在通过社区干预提升高血压患者的健康状况和依从性。研究选取某城市三个社区的300名高血压患者，随机分为实验组和对照组，实验组接受为期一年的社区综合管理模式，包括健康教育、定期随访和个性化指导，而对照组仅接受常规医疗服务。结果显示，实验组患者的血压控制率显著提高，达标率为78.3%，高于对照组的56.7%；同时，实验组的服药依从性和健康行为改善程度也优于对照组。此外，社区管理模式显著降低了患者的再住院率和急诊次数，体现了良好的经济和社会效益。本研究创新性地将多维度干预融入社区管理，并验证了其可行性和有效性，为推动高血压防控的基层化和规范化提供了重要参考。关键词：高血压管理; 社区干预; 健康教育
Abstract
Hypertension, as a common chronic disease worldwide, has a direct impact on patients' quality of life and medical burden, highlighting the importance of effective management strategies. This study aimed to explore a more efficient management model by improving the health status and compliance of hypertensive patients through community-based interventions. A total of 300 hypertensive patients from three communities in a city were selected and randomly divided into an experimental group and a control group. The experimental group received a one-year comprehensive community management intervention, which included health education, regular follow-ups, and personalized guidance, whereas the control group only received routine medical services. The results demonstrated a significant improvement in blood pressure control rates among the experimental group, with a compliance rate of 78.3%, compared to 56.7% in the control group. Additionally, the experimental group exhibited better medication adherence and healthier behavioral changes than the control group. The community management approach also significantly reduced readmission rates and emergency department visits, indicating substantial economic and social benefits. This study innovatively integrated multidimensional interventions into community management, validating its feasibility and effectiveness, and providing critical insights for promoting grassroots and standardized approaches to hypertension prevention and control.
Key words:Hypertension Management; Community Intervention; Health Education
中文摘要 I
英文摘要 II
引 言 1
第1章、高血压社区管理的背景与意义 2
1.1、高血压流行病学特征 2
1.2、社区管理的重要性分析 2
1.3、研究目标与内容概述 2
第2章、社区管理模式的设计与实施 4
2.1、模式设计的核心要素 4
2.2、实施流程与操作规范 4
2.3、关键环节的质量控制 5
第3章、临床应用的效果评估 6
3.1、血压控制水平的变化 6
3.2、患者依从性的影响因素 6
3.3、健康教育的作用分析 6
第4章、社区管理模式的优化与展望 8
4.1、当前模式存在的问题 8
4.2、改进策略与技术支持 8
4.3、未来发展方向探讨 8
结 论 10
参考文献 11
