摘要
目的探讨和建立有效降低北京崇文社区脑卒中发病、死亡及危险因素水平的长效机制与模式。方法选择有良好人群基础的崇文社区,建立以区卫生局领衔,下属3所医院为技术平台的社区人群脑卒中防治体系。培训社区医务人员和街道干部,创建慢性病与公共卫生相结合的基础队伍。在社区人群中开展危险因素水平的调查与评估,对高危人群进行综合性干预及全人群健康教育与促进。结果对1016例心脑血管病患者治疗依从性分析显示,男性和女性患者症状改善而自行停药者分别占35．5%和30．3%,每日坚持规律服药者分别占62．8%和69．6%;影响药物治疗的9项因素中,忘记服药、医疗费用高、家庭经济原因均＞20．0%,因药物产生不适反应而停药的男性和女性仅为17．8%和11．3%,女性遵守医嘱的依从性高于男性。经常进行体育锻炼的居民由基线调查时的53．9%上升到66．4%。从2004年、2003年脑卒中发病率、死亡率观测社区干预初见效果。结论在我国城市脑卒中高危人群中开展大规模、系统的社区综合性干预,群体健康教育与促进,可有效控制社区人群危险因素水平,对降低脑卒中发病率、死亡率有着重要意义。基层医院保健科医生经过系统慢性病防治培训,可承担起社区脑卒中综合性预防的基本职能,为我国社区公共卫生战略实施提供可操作性模式。
Objective To explore and institute community model and long-term mechanism to effectively decrease morbidity and mortality of stroke and stroke-related risk factors in the population of Chongwen district.Methods On the better basis of previous stroke prevention in the Chongwen of Beijing,a system of prevention and treatment for stroke including 3 local hospitals was established under the lead of the Chongwen Health Bureau.Directors of residents'committee and medical staffs from departments of chronic diseases and public health were organized and trained for stroke prevention.Comprehensive intervention on population at high risk of stroke and health education and promotion on the whole population were regularly carried out.Results Compliance analysis of 1016 patients with cardiovascular diseases showed that rates of stopping use of medicine due to relieving symptoms and regularly taking medicine were respectively 35.5% and 62.8% in male,30.3% and 69.6% in female;rates of forgetting to take medicine,high fees of medicine and family income out of inthence factors of drug treatment were all over 20%, rates of drug side effect resulting in medicine stop were 17.8% in male and 11.3% in female,rates of compliance to drug was higher in female than male.Rates of regularly physical exercises increased from 53.9% at baseline of investigation to 66.4%. Data of stroke morbidity and mortality rates in 2003 and 2004 suggested community-based intervention was effective.Conclu- sion Comprehensive intervention including health education and health promotion among Chinese urban population at high risk of stroke is important and beneficial for reducing levels of risk factors,morbidity and mortality.Medical staff from the public health department of local hospitals can have the function of comprehensive prevention and treatment for urban community after being sys- tematically trained in prevention and treatment of chronic disease,suggesting it is a practical model in the practice of public health.
出处
《中国卒中杂志》
2006年第8期539-542,共4页
Chinese Journal of Stroke
基金
首都医学发展科研基金项目(2002-1023)
关键词
社区人群
脑卒中
管理模式
Community population
Stroke
Organizational models
作者简介
通讯作者:吴升平,100050 北京市,北京市神经外科研究所神经流行病室;E-mail:wspepi1954@hotmail.com
