Standardized management and effect evaluation of hypertension community

1, the significance and content of standardized management of hypertension in community

Standardized management of hypertension is conducive to improving the treatment rate and compliance rate of hypertension, reducing the occurrence of cardiovascular and cerebrovascular diseases and improving the health status of the people. Main contents of standardized management of hypertension community:

2。 1 health education

Health education and hypertension prevention knowledge education for normal people, people susceptible to hypertension and patients with hypertension mainly include:

① Normal population: Knowing about hypertension, it is recommended to measure blood pressure once a year.

② Susceptible population: intervention related risk factors (such as obesity, high-salt diet, excessive drinking, long-term mental stress, etc.). ) to prevent the occurrence of hypertension.

③ Hypertensive people: recognize the harm of hypertension, persist in changing unhealthy lifestyles, adhere to standardized drug treatment, and prevent cardiovascular and cerebrovascular diseases.

2.2 Non-drug therapy

Long-term adherence to non-drug treatment. Hypertension is a "lifestyle disease". Only by improving unhealthy lifestyle can we completely control hypertension and related risk factors. It is necessary to have a reasonable diet, limit fat intake, quit smoking, limit alcohol (men drink no more than 1 2 per day), limit salt (5 grams of salt per person per day), exercise properly, keep a good mood and avoid long-term mental stress.

2.3 Standardized drug therapy

According to the specific situation of patients, use appropriate antihypertensive drugs. Diuretics, beta blockers, calcium antagonists, ACEI, ARB and low-dose compound preparations can all be used as initial and maintenance drugs. Adhere to long-term treatment and control blood pressure steadily. Don't stop using antihypertensive drugs at will. Measure blood pressure regularly and advocate self-testing blood pressure.

2.4 standardized management

Detection of hypertension from the population and risk assessment. According to low, medium, high risk/extremely high risk, it is divided into one, two and three levels of management.

First-level management, second-level management and third-level management.

Low risk, medium risk, high risk/extremely high risk

Create a health record immediately.

Start non-drug treatment immediately.

Start drug treatment observation for 6 months, observe for 3 months, and start immediately.

At least once every 3 months, at least once every 2 months, at least once every 1 month, with visiting period and blood pressure measurement times.

Laboratory examination according to the condition according to the condition according to the condition.

3. Evaluation of hypertension management effect

Hypertension community assessment indicators:

① Management coverage rate

② Standardized management rate

③ blood pressure control rate (blood pressure < 140/90mmhg)

④ Awareness rate of hypertension knowledge

The above items (1), (2) and (4) shall be formulated according to local actual conditions. About the management of diabetes:

Materials and methods

PARTICIPANTS: Patients who meet the diagnostic criteria of diabetes in WHO community, aged 465,438 0 ~ 77 years.

Form: 1 taught by our general practitioner or endocrinologist of superior hospital every month, and taught patients in various ways through cooperation with neighborhood committees: what is diabetes, the symptoms of diabetes, the risk of complications of heart, brain, kidney, eyes and feet, especially the importance of foot care; Reasonable lifestyle and diet plan, the importance of regular exercise; Correlation between diet, exercise, oral hypoglycemic agents, insulin or other drugs; The significance of self-monitoring of blood sugar and urine sugar and the measures to be taken; Patients should know the standards of blood sugar, blood pressure, blood lipid and weight. After each lecture, patients can consult professors or doctors according to their own condition and find out the best way to control their condition in combination with their own reality. Health education prescriptions are also distributed to patients, which are easy to understand and practical. Play a DVD of diabetes prevention, diabetes diet and exercise therapy for patients every half month.

Family members of diabetic patients should also receive health education: diabetes is a chronic disease, and family support can provide patients with a good treatment and recuperation environment, help patients overcome the slack caused by their illness, and effectively urge and guide patients to carry out self-management and preventive health care. Teach family members how to deal with the adverse reactions of patients taking medicine at home, the prevention of hypoglycemia and the countermeasures when they forget to take medicine.

Establishing health records: establishing health records for patients with diabetes who have been diagnosed. File 1 in triplicate: basic information, follow-up form and annual inspection form. Every form is filled in in detail, and there are no blank items. When placed, they are numbered according to the community, unit building and house number. As long as the patient says his address, he can quickly find his file. For patients with stable blood sugar, blood sugar is measured twice a month, glycosylated hemoglobin is measured every 3 ~ 6 months, urinary microprotein, blood lipid and electrocardiogram are measured every 6 ~ 12 months, and liver function, renal function and fundus are measured every year. Individualized treatment and health care programs are given to those who find abnormal indicators. Through the establishment of health records, the contact with patients is maintained, health care knowledge and skills can be conveyed to patients in time, and the compliance of patients with medical treatment is improved [1].

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Solid theoretical knowledge, good professional quality and skillful communication skills are the guarantee for diabetic patients to receive education. When the medical staff in this service station contact patients for the first time, they should not only show the dignity of doctors, but also respect patients, so that patients do not feel constrained and lay a good foundation for patients to adhere to health management in the future. Self-care of diabetic patients is complicated, which requires perceptual knowledge, restraint, behavioral adaptation and will to implement. The process of health education, treatment and nursing of diabetes requires many steps. For example, elderly diabetic patients are prone to hypoglycemia. In health education, in addition to teaching patients how to calculate and measure, choose the position and master the method of using insulin, they must also teach patients to eat flexibly, and ask patients to add meals after exercise and avoid taking a bath before meals. In addition, if elderly patients sweat a lot at night, they should be reminded to be vigilant to prevent hypoglycemia coma. Elevated blood pressure is a risk factor and should be controlled. The degree of compliance behavior of diabetic patients directly affects the therapeutic effect. Effective health education can improve patients' consciousness of following doctor's advice and lay the foundation for achieving the best treatment goal [2, 3].

At the beginning, most patients didn't understand the health records and had resistance. Through the communication between medical staff and patients, files are gradually established. For example, if a patient forgets to check glycosylated hemoglobin regularly, he will call the patient in time to check and guide the patient to promote health systematically.

Diabetes is a lifelong disease, and the treatment of diabetes should adhere to the comprehensive treatment methods of dietotherapy, physiotherapy and drug treatment. Among them, diet therapy is the most basic treatment. If you control it well, you can live a normal life. Diabetes is a common disease in middle-aged and elderly people. If it is not well controlled, it will cause some complications. Treatment is often a combination of diet, exercise and medicine, in which dietotherapy is the basis of all treatments. For mild diabetes, only diet therapy can control the condition. The basic principle of dietotherapy is to estimate the total calories needed and arrange the daily diet reasonably according to the patient's weight and activity. Don't eat foods with high sugar content, eat less foods containing fat and starch, mainly vegetables and miscellaneous grains, with a certain amount of high-quality protein foods such as lean meat, milk, eggs and bean products.

Fruit contains sugar, can I eat fruit? Fruit contains a lot of vitamins, cellulose and minerals, which is beneficial to diabetics. The sugars contained in fruits are glucose, fructose and sucrose, among which fructose does not need insulin to participate in metabolism. Therefore, diabetic patients do not reject fruits after their blood sugar is controlled. Moreover, the sugar content of fruits is different and cannot be treated equally. Food per 100 g is less than 100g, including plums, watermelons, melons, coconut milk, oranges, lemons, grapes, peaches, plums, apricots, loquats, pineapples, strawberries, sugar cane, coconuts, cherries and olives. , available for diabetics to choose from. Fruits with sugar content of 1 1 ~ 20g include bananas, pomegranates, pomelos, oranges, apples, pears, lychees and mangoes, which should be carefully selected. There are dates and red fruits over 20g, especially dried dates, candied dates, dried persimmons, raisins, dried apricots and longan. It is forbidden to eat because of its high sugar content. Many vegetables can be eaten as fruits, such as tomatoes, cucumbers and melons. The sugar content per 100g is below 5g, and they are rich in vitamins, which can completely replace fruits and are suitable for diabetics. In addition, the amount of food should be matched, not the same. Watermelon contains less sugar (4%), but if you eat 500g, it is equivalent to banana 100 g (sugar content 20%) and pear 170 g (sugar content 12%), so the above fruits should not be eaten too much. You should also pay attention to the way you eat fruit. Don't eat immediately after meals, but eat between meals or before going to bed. It is best to try to eat, that is, measure urine sugar 2 hours after eating. If urine sugar increases, it needs to be reduced; If urine sugar is still high after fruit reduction, the amount of staple food should be reduced appropriately.

In short, for patients with chronic diseases such as diabetes and hypertension in the community, the work of community medical staff should not be limited to traditional disease treatment and nursing, but should focus on teaching patients how to prevent and treat diseases and how to adhere to correct treatment and correct living habits. Therefore, doing a good job in health management of behavior implementation can not only improve patients' compliance consciousness, make patients actively participate in health maintenance plan, reduce and delay complications, but also improve treatment effect and reduce medical expenses.

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