Efficacy of community nurses involving in management of antihypertensive drug medication list in elderly patients with essential hypertension in community

doi:10.3760/cma.j.issn.1007-1245.2023.02.033

Abstract

Abstract:

Objective　To explore efficacy of community nurses involving in the management of antihypertensive drug medication list in elderly patients with essential hypertension in community. Methods　From September 2021 to March 2022, 480 elderly patients with essential hypertension in the community treated at Shunyu Road Community Clinic, Jinan Maternal and Child Health Hospital were selected for the random control trial. The random number table method was used to divide the patients into a control group and a study group, with 240 cases in each group. The control group received routine antihypertensive drug guidance for 3 months. In the study group, the community nurses involved in the management of antihypertensive drug medication list for 3 months. The Morisky Medication Adherence 8-item Scale (MMAS-8) was used to evaluated the compliance of antihypertensive medication at the time of enrollment and after 1 and 3 months' intervention. The systolic blood pressures (DBP) and diastolic blood pressures (SBP) at the time of enrollment and after 1 and 3 months' intervention were recorded; the qualified rate of blood pressure control was calculated. The independent-sample t test, χ² test, and analysis of variance were applied. Results　A total of 219 cases in the control group and 221 cases in the research group were included in the final analysis. There were 126 males and 93 females in the control group; they were 62-87 (76.40±8.26) years old; the course of hypertension was (6.82±2.64) years. There were 132 males and 89 females in the study group; they were 61-90 (76.28±8.41) years old; the course of hypertension was (6.76±2.72) years. After 1 and 3 months' intervention, the MMAS-8 scores in the study group were higher than those in the control group [(6.25±0.91) vs. (5.36±0.84) and (6.78±0.83) vs. (5.64±0.86); t=10.646 and 14.148; both P<0.001]; the SBP's [(138.42±12.98) mmHg (1 mmHg=0.133 kPa) vs. (142.28±13.75) mmHg and (130.18±11.24) mmHg vs. (137.75±12.68) mmHg; t=3.028 and 6.847; P=0.003 and <0.001] and DBP's [(87.24±9.30) mmHg vs. (90.15±9.86)mmHg and (84.10±8.64) mmHg vs. (87.60±9.25) mmHg; t=3.185 and 4.102; P=0.002 and <0.001] in the study group were lower than those in the control group. The qualified rate of blood pressure control after 3 months' intervention in the study group was higher than that in the control group [77.83 (172/221) vs. 58.45 (128/219); χ²=19.045, P<0.001]. Conclusions　Community nurses involving in the management of antihypertensive drug medication list in elderly patients with essential hypertension in community can improve their compliance taking antihypertensive drugs, pressure control effect, and the qualified rate of blood pressure control.

Key words:

Essential hypertension, Medication list, Community nurses, Antihypertensive drug management, Community nursing, Elderly

摘要：

目的　探讨社区护士介入社区老年原发性高血压患者降压药用药清单管理效果。方法　选取2021年9月至2022年3月济南市妇幼保健院舜玉路社区门诊收治的480例社区老年原发性高血压患者进行随机对照试验，采用随机数字表法将其分对照组与研究组，各240例。对照组开展常规降压药物指导，研究组开展社区护士介入社区老年原发性高血压患者降压药用药清单管理，均持续3个月。采用Morisky用药依从性8条目量表（MMAS-8）评价入组时、干预1个月、干预3个月降压药物服用依从性；并记录入组时、干预1个月、干预3个月收缩压（DBP）与舒张压（SBP），计算血压控制达标率。采用独立样本t检验、χ²检验和方差分析。结果　对照组219例，研究组221例纳入最终分析。对照组男126例，女93例，年龄62～87（76.40±8.26）岁，高血压病程（6.82±2.64）年。研究组男132例，女89例，年龄61～90（76.28±8.41）岁，高血压病程（6.76±2.72）年。干预后1个月、3个月研究组MMAS-8评分［（6.25±0.91）分比（5.36±0.84）分、（6.78±0.83）分比（5.64±0.86）分；t=10.646、14.148，均P<0.001］均高于对照组，SBP［（138.42±12.98）mmHg（1 mmHg=0.133 kPa）比（142.28±13.75）mmHg、（130.18±11.24）mmHg比（137.75±12.68）mmHg；t=3.028、6.847，P=0.003、<0.001］及DBP［（87.24±9.30）mmHg比（90.15±9.86）mmHg、（84.10±8.64）mmHg比（87.60±9.25）mmHg；t=3.185、4.102，P=0.002、<0.001］均低于对照组。研究组干预3个月后血压控制达标率高于对照组［77.83（172/221）比58.45（128/219）；χ²=19.045，P<0.001］。结论　社区护士介入社区老年原发性高血压患者降压药用药清单管理可提升患者服用降压药物的依从性，增强血压控制效果，提升血压控制达标率。

关键词:

原发性高血压, 用药清单, 社区护士, 降压药管理, 社区护理, 老年

Jia Zhongyuan, Zhang Zongli, Gao Lijuan.

Efficacy of community nurses involving in management of antihypertensive drug medication list in elderly patients with essential hypertension in community [J]. International Medicine and Health Guidance News, 2023, 29(2): 282-.

贾忠媛张宗丽高丽娟.

社区护士介入社区老年原发性高血压患者降压药用药清单管理效果 [J]. 国际医药卫生导报, 2023, 29(2): 282-.

References

[1] «心肺血管病杂志»编辑部. 中国心血管健康与疾病报告2019[J]. 心肺血管病杂志,2020,39(9):1145-1156. DOI:10.3969/j.issn.1007-5062.2020.09.028.
[2] Xhignesse P, Krzesinski F, Krzesinski JM. Hypertensive crisis [J]. Rev Med Liege, 2018, 73(5-6): 326-332.
[3] «中国高血压防治指南»修订委员会. 中国高血压防治指南2018年修订版[J]. 心脑血管病防治,2019,19(1):1-44. DOI:10.3969/j.issn.1009-816X.2019.01.001.
[4] Rocco MV, Comeau ME, Marion MC, et al. Effects of intensive systolic blood pressure control on all-cause hospitalizations [J]. Hypertension, 2020, 76(6):1717-1724. DOI: 10.1161/HYPERTENSIONAHA. 120.15868.
[5] 国家心血管病中心国家基本公共卫生服务项目基层高血压管理办公室,国家基层高血压管理专家委员会. 国家基层高血压防治管理指南2020版[J]. 中国循环杂志,2021,36(3):209-220. DOI:10.3969/j.issn.1000-3614. 2021.03.001.
[6] 中华医学会,中华医学会临床药学分会,中华医学会杂志社,等. 高血压基层合理用药指南[J]. 中华全科医师杂志,2021,20(1):21-28. DOI:10.3760/cma.j.cn114798-20201118- 01164.
[7] 周荆津. 目标控制理论指导下共享决策感知干预对冠心病患者的影响[J]. 国际医药卫生导报,2020,26(15):2323-2325. DOI:10.3760/cma.j.issn.1007-1245. 2020.15.049.
[8] Zhang Y, Wang R, Chen Q, et al. Reliability and validity of a modified 8-item Morisky Medication Adherence Scale in patients with chronic pain [J]. Ann Palliat Med, 2021, 10(8): 9088-9095. DOI: 10.21037/apm-21-1878.
[9] 李皓洁,陈雪娇,胡雪琪,等. 河南省老年人高血压服药情况及影响因素分析[J]. 现代预防医学,2022,49(7):1264-1268.
[10] 徐亚萍,章如山,邹剑飞,等. 安庆市农村老年高血压患者服药依从性现状[J]. 山东第一医科大学(山东省医学科学院)学报,2022,43(3):230-234. DOI:10.3969/j.issn. 2097-0005. 2022.03.015.
[11] 陈希,严青华,吴菲,等. 上海市社区高血压患者服药依从性现况及其影响因素分析[J]. 现代预防医学,2022,49(1):72-76.
[12] 王玉霞,谭坦,赵莉,等. 青岛市社区高血压患者降压药物使用现状及服药依从性分析[J]. 预防医学论坛,2022,28(1):47-51.
[13] Lor M, Koleck TA, Bakken S, et al. Association between health literacy and medication adherence among Hispanics with hypertension [J]. J Racial Ethn Health Disparities, 2019, 6(3):517-524. DOI: 10.1007/s40615-018-00550-z.
[14] 于坤,叶恒,魏浩然,等.湖北省农村高血压控制现状流行病学调查[J].辽宁医学杂志,2021,35(3):18-21.
[15] 刘辉,陈长,蔺阳刚,等. 老年急性缺血性脑卒中患者直立性低血压状态与卒中后认知障碍相关性研究[J]. 中华老年心脑血管病杂志,2021,23(2):128-131. DOI:10.3969/j.issn.1009-0126.2021.02.005.
[16] Arguedas JA, Leiva V, Wright JM. Blood pressure targets in adults with hypertension [J]. Cochrane Database Syst Rev, 2020, 12(12):CD004349. DOI: 10.1002/14651858.CD004349.pub3.
[17] 陈淑结,唐明虹,谭瑞玉. 社区护士主导的健康自我管理在老年原发性高血压患者中的应用效果[J]. 国际医药卫生导报,2021,27(14):2196-2199. DOI:10.3760/cma.j.issn.1007-1245.2021.14.040.
[18] Kolcu M, Ergun A. Effect of a nurse-led hypertension management program on quality of life, medication adherence and hypertension management in older adults: a randomized controlled trial [J]. Geriatr Gerontol Int, 2020, 20(12): 1182-1189. DOI: 10.1111/ggi.14068.
[19] 董婷,刘素珍,李继平,等. 社区护士主导的团队对高血压患者的管理及效果评价[J]. 中华护理杂志,2017,52(6):680-685. DOI:10.3761/j.issn.0254-1769.2017.06.008.
[20] Persell SD, Karmali KN, Lazar D, et al. Effect of electronic health record-based medication support and nurse-led medication therapy management on hypertension and medication self-management: a randomized clinical trial [J]. JAMA Intern Med, 2018, 178(8):1069-1077. DOI: 10.1001/jamainternmed.2018.2372.