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目的探索农村地区开展高血压社区防治的模式,为防治高血压病提供依据。方法以户为单位为村民建立健康档案,按一般人群、高危人群、患者人群分类管理,实施不同的干预措施。结果项目实施后,一般人群健康行为有所改善,但健康行为符合率仍不到1/5;入组患者高血压KAP各项得分高于非入组患者(P<0.001);人群分类健康教育活动显示,一般人群受益比例最低(30.1%),患者人群最高(60.3%);管理患者和管理高危人群的血压水平均有程度不同的下降,其中管理患者的血压控制效果达优良等级达53.3%,管理高危人群有56.5%转为正常血压(<130 mmHg/85 mmHg)。结论在农村社区开展高血压防治服务,廉价有效。高危人群干预是关键抓手,可以起到事半功倍的效果。
Objective To explore the mode of community prevention and treatment of hypertension in rural areas and provide basis for prevention and treatment of hypertension. Methods The health archives were set up for the villagers on a household basis. According to the classification management of the general population, the high risk population and the patient population, different interventions were implemented. Results After the implementation of the project, the general population health behavior improved, but the compliance rate of healthy behavior was still less than 1/5. The scores of KAP in hypertension group were higher than those of non-inclusion group (P <0.001) Activities showed that the general population benefit lowest (30.1%), the highest patient population (60.3%); management of patients and management of high-risk groups, blood pressure levels have varying degrees of decline, including management of patients with excellent blood pressure control level of 53.3% , 56.5% of those who manage high-risk groups turned to normotensive (<130 mmHg / 85 mmHg). Conclusions Hypertension prevention and treatment services in rural communities are cheap and effective. High-risk groups intervention is the key start, can play a multiplier effect.