为推进社区慢病防治工作,探索慢病社区干预模式,根据本社区实际情况,笔者将高血压、糖尿病作为该社区优先干预的疾病,探索以社区为平台,以健康教育和健康促进为基本手段,以个体化的高血压、糖尿病患者管理为主要措施的社区高血压、糖尿病防治模式。现制订社区高血压病、糖尿病干预 To promote community-based chronic disease prevention and treatment and to explore the community intervention model for chronic diseases, according to the actual situation in this community, the author regards hypertension and diabetes as the priorities of the community and explores community-based strategies and health education and health promotion as basic measures , To individualized hypertension, diabetes management as the main measure of community hypertension, diabetes prevention and control mode. Is to develop community hypertension, diabetes intervention