基于互联网的社区高血压自我管理干预模式建立与评价

发布时间：2018-08-04 19:44

【摘要】：目的建立并评价基于互联网的社区高血压自我管理干预模式,探索在互联网新媒体背景下的慢性病管理服务新模式,进一步提升慢性病防控效果。方法本研究组建研发小组,结合《慢性病自我管理实践》等指南或著作内容,形成基于互联网的社区高血压自我管理干预模式的主要结构与内容,方案完全自主设计,委托广东福来健康科技有限公司按设计方案开发。该模式主要框架内容有血压、心率、运动、膳食、心理风险等实时监测,健康综合评价,个性化运动、膳食、心理处方的制定,行动计划与目标的制定,波动异常提醒建议与制定,健康教育内容的制定与推送,健康咨询等内容,最后形成以互联网为媒介,以社区自我管理干预系统为平台,以手机微信客户端为监测载体,以智能运动手环、智能电子血压计为监测工具的新型自我管理干预模式。本研究以居委为单位,对广州市番禺区东环街社区卫生服务中心所有管辖居委随机抽取三个居委(富豪、东环、番艺),随机分组。共招募高血压患者106例,富豪居委招募53例为实验组,番艺居委和东环居委分别招募27例、26例为对照组。实验组接受基于互联网的社区高血压自我管理干预模式,对照组接受常规自我管理干预模式。实验组和对照组干预时间均为6个月。干预前对两组高血压患者进行基本情况调查,包括性别、年龄、婚姻状况、文化程度、服药情况、每月医药费、遗传史等内容。对两组高血压患者干预前后评价指标进行测量,包括血压,体适能,身体活动量,行为改变阶段,膳食,心理,生化指标、自我效能和疾病认知等内容测量。膳食评价采用3天24小时膳食回顾和家庭膳食食谱登记相结合的方法,心理和自我效能评价采用生存质量量表、抑郁量表、焦虑量表、长谷川式简易智能评定表、自我效能量表评价。数据收集与分析:运用SPSS 21.0软件对数据整理和统计分析,采用定量和定性分析相结合的方法对基于互联网的社区高血压自我管理干预模式进行效果评价。率的比较采用卡方检验和确切概率法,计量资料采用t检验方法,定性研究采用小组访谈法。结果1.基于互联网的高血压自我管理干预模式本研究利用自主研发的“互联网+”社区高血压自我管理平台,建立一种以社区为基础、以互联网为载体、以智能可穿戴设备为监测工具,以患者为中心,以个性化干预为措施的高血压自我管理干预模式。该模式主要由医生决策系统、个性化干预决策系统和自我管理手机应用系统(微信客户端)组成。医务人员通过该平台实时监测患者的血压、心率、膳食、运动、心理、症状等指标,综合评估,为患者及时提供个性化指导和精准健康支持,并实时监测和推送个性化健康评价报告、个性化膳食处方、个性化运动处方、个性化心理指导、高血压知识图文消息、减脂目标、线上线下健康咨询等。患者执行健康计划和目标,并实时反馈。期间,医务人员与患者不断交流反馈,修改目标和计划,直到找到适宜自身的个性化干预。2.两组高血压患者干预前后干预效果比较(1)两组干预前后血压、控制率、服药率变化:实验组干预后的收缩压较干预前减少5.8mm Hg,差异有统计学意义(p0.05);对照组干预后的收缩压较干预前减少2.9 mm Hg,差异无统计学意义(p0.05)。实验组和对照组干预前后舒张压、控制率、服药率差异均无统计学意义(p0.05)。实验组干预前后收缩压差值、舒张压差值、控制率、服药率与对照组比较差异均无统计学意义(p0.05)。(2)两组干预前后生化指标变化:实验组干预前后红细胞差值、血清肌酐差值、血钾浓度差值、同型半胱氨酸差值、血清低密度脂蛋白胆固醇差值和血清高密度脂蛋白胆固醇差值与对照组比较差异有统计学意义(p0.05)。实验组干预后的同型半胱氨酸、红细胞较干预前有所改善,差异有统计意义(p0.05);对照组干预后的白蛋白、同型半胱氨酸、血钾浓度、血钠浓度、血清高密度脂蛋白胆固醇与干预前比较差异均有统计意义(p0.05)。实验组和对照组干预前后其他生化指标差值与对照组比较差异均无统计学意义(p0.05)。(3)两组干预前后体适能、身体活动量、行为改变阶段、腰围、BMI变化:实验组干预前后肺活量差值、选择反应时差值、身体活动量差值、腰围差值比对照组有所改善,差异有统计学意义(p0.05)。实验组的肺活量、选择反应时、身体活动量、行为改变阶段、腰围干预前后比较差异均有统计学意义(p0.05)。对照组的闭眼单脚站立干预前后比较差异有统计学意义(p0.05)。实验组干预前后BMI差值、握力差值、坐位体前屈差值和闭眼单脚站立差值与对照组比较差异均无统计学意义(p0.05)。(4)两组干预前后膳食变化:实验组干预前后谷薯类实际摄入量差值、水果类差值、钙差值、碘差值较对照组有所改善(-91.2g、38.4g、181.7mg、0.3mg)差异均有统计学意义(p0.05)。实验组蔬菜类、谷薯类、畜禽水产品、盐、胆固醇、钙、钾、碘的实际摄入量干预前后比较差异均有统计学意义(p0.05)。对照组各类食物和营养素实际摄入量干预前后比较差异均无统计学意义(p0.05)。实验组其他各类食物、能量和营养素实际摄入量干预前后差值与对照组比较差异均无统计学意义(p0.05)。(5)两组干预前后生存质量、抑郁、焦虑、认知功能变化:实验组干预前后活力差值、社会功能差值、情感职能差值、心理健康差值、焦虑差值和认知功能差值与对照组比较差异有统计学意义(p0.05)。实验组干预后的躯体疼痛、情感职能得分较干预前高(10.0分、23.9分),焦虑、抑郁得分较干预前低(-14.0分、-4.4分),差异均有统计意义(p0.05);对照组干预后的生存质量、抑郁、焦虑、认知功能得分与干预前比较差异均无统计意义(p0.05)。实验组干预前后生理功能差值、生理职能差值、躯体疼痛差值、总体健康差值、健康变化差值、抑郁差值与对照组比较差异均无统计学意义(p0.05)。(6)两组干预前后自我效能、疾病认知变化:实验组干预前后自我效能差值、疾病认知差值与对照组比较差异有统计学意义(p0.05)。实验组干预后的疾病认知、症状管理、一般疾病管理比干预前得分高(2.0分、5.4分、1.7分),差异均有统计意义(p0.05);对照组干预后的疾病认知、症状管理、一般疾病管理与干预前比较差异均无统计意义(p0.05)。3.定性研究:医务人员均认为基于互联网的社区高血压自我管理干预模式可以拉近医患关系,提高医生健康服务质量和效率,提高社区高血压管理率。高血压患者也对该模式比较满意,认为能解决他们实际健康问题,能满足他们的需求。结论本研究发现,针对社区高血压患者自我管理而言,基于互联网的社区高血压自我管理干预模式在血压、体适能、身体活动量、行为改变阶段、膳食、生化指标、心理、疾病认知和自我效能等方面较常规自我管理干预模式有更好的干预效果,且具有实时性、参与性、个性化、普及性等优点。因此,在社区大力推广基于互联网的社区高血压自我管理干预模式是一项可行的慢性病防控新举措。
[Abstract]:Objective to establish and evaluate the self-management intervention model of community hypertension based on the Internet, explore a new model of chronic disease management under the background of Internet new media, and further improve the effectiveness of chronic disease prevention and control. The main structure and content of the self-management intervention model of the community hypertension self-management, the scheme is completely designed and commissioned by Guangdong Fulai Health Science and Technology Co., Ltd. according to the design scheme. The main frame of the model is the real-time monitoring of blood pressure, heart rate, exercise, diet, psychological risk, health comprehensive evaluation, personalized exercise, diet, psychological prescription. The formulation, the formulation of the action plan and the target, the suggestion and the formulation of abnormal fluctuation, the formulation and push of the health education content, the health consultation and so on, and finally form the Internet as the medium, the community self management intervention system as the platform, the mobile WeChat client as the monitoring carrier, the intelligent sport ring, the intelligent electronic sphygmomanometer A new type of self-management intervention model of monitoring tools was used in this study. In this study, we randomly selected three residential committees (the rich, the east ring, and the art) in the community health service center of Panyu District east ring street, Guangzhou, at random, recruited 106 cases of hypertensive patients, and 53 cases were recruited by the rich residence Committee as the experimental group, the Committee of the Fang Yi Ju and the east ring residence. The group received 27 cases and 26 cases as the control group. The experimental group accepted the self-management intervention model of community hypertension based on the Internet, and the control group received routine self management intervention. The intervention time of the experimental group and the control group were 6 months. Before the intervention, the basic situation of two groups of hypertensive patients, including sex, age, marital status, was studied. Two groups of hypertensive patients were measured before and after intervention, including blood pressure, physical fitness, physical activity, behavior change stage, diet, psychology, biochemical index, self-efficacy and cognition of disease. Dietary evaluation adopted 3 days and 24 hours diet review and family. The method of combination of dietary diet registration, psychological and self-efficacy evaluation adopted quality of life scale, depression scale, anxiety scale, Kyohko Hasegawa simple intelligence assessment table, self-efficacy scale evaluation. Data collection and analysis: using SPSS 21 software for data sorting and statistical analysis, the method of combining quantitative and qualitative analysis to the basis of the method The effect evaluation on the self-management intervention model of hypertension in the community was conducted. The ratio of the rate was compared with the chi square test and the exact probability method, the t test method was used in the measurement data, and the qualitative research was conducted by the group interview. Results 1. the self-developed "Internet +" community based on the independent research and development of the self-developed "Internet +" community based on the Internet based hypertension self management intervention model was used. The self management platform of hypertension is based on the community as the basis, the Internet as the carrier, the intelligent wearable equipment as the monitoring tool, the patient as the center, and the individualized intervention as the measure of self management intervention. The model is mainly composed of the doctor decision-making system, the personalized intervention decision system and the self managed mobile application department. The medical staff can monitor the patient's blood pressure, heart rate, diet, exercise, psychology, symptoms and so on through this platform, to provide personalized guidance and accurate health support for patients in time, and to monitor and push personalized health evaluation report in real time, personalized diet prescription, individualized exercise prescription and personality. Psychological guidance, hypertension knowledge graphic message, fat reduction target, online and offline health counseling. Patients perform health plans and goals, and real-time feedback. During the period, medical staff and patients continue to exchange feedback, modify target and plan, until the intervention effect ratio of two groups of hypertension patients before and after intervention are found to be suitable for their own individual intervention. Compared with (1) the two groups, the blood pressure, control rate, and drug rate were reduced before and after the intervention: the systolic pressure of the experimental group was reduced by 5.8mm Hg than before the intervention (P0.05); the systolic pressure of the control group decreased by 2.9 mm Hg before the intervention (P0.05). The diastolic pressure, control rate, and drug rate before and after the intervention of the experimental group and the control group were not statistically significant. The difference was not statistically significant (P0.05). There was no significant difference in the difference of systolic pressure, diastolic pressure difference, control rate and drug rate between the experimental group and the control group before and after intervention (P0.05). (2) the changes of biochemical indexes before and after the intervention of the two groups: the difference of red blood cells, the difference of serum creatinine, the difference of blood potassium concentration, and the difference of homocysteine before and after the intervention of the experimental group The difference between the difference of serum low density lipoprotein cholesterol and serum HDL-C was statistically significant (P0.05). The prognosis of homocysteine in the experimental group was better than that before the intervention, and the difference was statistically significant (P0.05). The difference of blood sodium concentration and serum HDL cholesterol before intervention was statistically significant (P0.05). There was no significant difference in the difference of other biochemical indexes between the experimental group and the control group before and after the intervention (P0.05). (3) the body activity, the change of behavior, the waist circumference, and the change of BMI: the experimental group. The difference of vital capacity before and after intervention, the difference value of reaction time, the difference value of body activity and the difference between the waist circumference, and the difference were statistically significant (P0.05). The vital capacity of the experimental group, the physical activity and the behavior change stage in the experimental group were statistically significant (P0.05) before and after the waist circumference intervention (P0.05). The closed eye of the control group was closed to the single foot. There was significant difference between before and after standing intervention (P0.05). There was no significant difference in the difference value of BMI, the difference of grip strength, the difference of the front flexion of the sitting body and the difference between the close eye and the single foot before and after the intervention of the experimental group (P0.05). (4) the dietary changes before and after the intervention of the two groups: the difference between the actual intake of the potato and the fruit before and after the intervention of the experimental group, and the poor fruit The difference of -91.2g, 38.4g, 181.7mg, 0.3mg was statistically significant (P0.05). The difference of the actual intake of vegetable, valley, potato, animal and poultry, salt, cholesterol, calcium, potassium and iodine was statistically significant (P0.05) in the experimental group (P0.05). The actual intake of food and nutrients in the control group was significant (P0.05). There was no statistical difference before and after intervention (P0.05). There was no significant difference in the difference of the actual intake of energy and nutrients between the experimental group and the control group before and after intervention (P0.05). (5) the quality of life, depression, anxiety, cognitive function before and after the intervention of the two groups: the difference of vigor and social function before and after the intervention of the experimental group Difference, emotional function difference, mental health difference, anxiety difference and cognitive function difference were statistically significant (P0.05). The scores of emotional function in the experimental group were higher than before intervention (10, 23.9), anxiety and depression were lower than before intervention (-14.0, -4.4), and the difference was statistically significant (P0.05). There was no statistically significant difference in quality of life, depression, anxiety, cognitive function scores and before intervention in the control group (P0.05). There was no significant difference in the difference of physiological function, the difference of physiological function, the difference of physical pain, the difference of physical pain, the difference of total health, the difference of health, the difference of health and the difference of depression with the control group (6). (P0.05). The difference of self efficacy before and after the intervention of the two groups: the difference of self efficacy before and after the intervention of the experimental group, the difference of the difference between the disease cognition and the control group was statistically significant (P0.05). The disease cognition, the symptom management and the general disease management in the experimental group were higher (2, 5.4, 1.7), and the difference was statistically significant (P0.05) The difference of disease cognition, symptom management and general disease management before intervention in the control group had no statistical significance (P0.05).3. qualitative research: the medical staff thought that the community hypertension self-management intervention model based on the Internet could close the doctor-patient relationship, improve the health service quality and efficiency of the doctors, and improve the community hypertension management. The study found that the self-management intervention model of community hypertension based on the Internet is in the blood pressure, physical fitness, physical activity, behavior change stage, diet, and diet based on the self management of hypertension patients in community. Food, biochemical indicators, psychology, disease cognition and self-efficacy have better intervention effects than the conventional self-management intervention models, and have the advantages of real time, participatory, individualized and universal. Therefore, it is a feasible and feasible way to prevent and control chronic disease prevention and control in community based on the Internet based community hypertension self management intervention model. Move.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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