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1、中国社区高血压管理存在的问题及策略孙英贤中国医大一院心内科国内外高血压管理的理想模式芬兰的“北卡曙光”北欧美丽的千湖之国芬兰，经济繁荣，国民生活富足，但原来冠心病年死亡率却达800/10万，居世界之冠。严峻的形势促使政府下了决心，请世界卫生组织的专家到发病率最高的北卡地区指导冠心病社区防治。10年后的试点结果：男性烟民从50％下降到33％；吃黄油的人从90％下降到20％左右；北加里里男、女冠心病死亡率分别下降了24％、51％。全国范围内死于冠心病下降了44％，从500/10万降低280/10万：其中3
2、5-64岁的男性，冠心病死亡率下降了49％，即从70年代的720/10万，下降到90年代的360/10万。这一出人意料的结果，被称为照亮了心血管病预防之路的“北加里里曙光”，为许多国家仿效。国外高血压管理的模式ESC2013高血压指南：高血压管理系统应包括：thegeneralpractitioner,whoshouldtakecareofthemajorityofhypertensivepatients;medicalspecialistsfromvariousfieldsdependingonth
3、enatureofthehypertensionandthedifficultyposedbyitstreatment;specificallytrainednursestocloselyfollowthepatientduringhisorherlifetimetreatment;andpharmacistswhohandlephysicians’prescriptionsandoftenhavetodealdirectlywiththepatients’problemsandreplytohiso
4、rherquestions.Inanidealsetting,allhealthcareprovidersshouldco-operateinasuccessfullifetimeinterventionagainstthiscondition.Teamapproachindiseasemanagement-ESC2013Thebeneficialeffectoftheinvolvementofpharmacistsandnursesinthemanagementofhypertensionhasbe
5、enobtained.whentheirtaskinvolvedpatienteducation,behaviouralandmedicalcounselling,assessmentofadherencetotreatment,and,forpharmacists,interactionwithphysiciansintheareaofguideline-basedtherapy.Clearly,team-basedstrategiesofferanimportantpotentialmethodf
6、orimprovementofantihypertensivetreatmentcomparedwithstrategiesinvolvingphysiciansalone.Modeofcaredelivery-ESC2013Methodsforthedeliveryofcareare,available,suchastelephoneinterviewsandadvancedtelemedicine(includingvideoconferences).Telephonecontactsareeff
7、ectiveinchangingpatientbehaviours,withtheadditionalpotentialadvantagethat,comparedwithface-to-facecontact,(i)morepatientscanbereached,(ii)littleornotimeorworkinghoursarelost,and(iii)contactscanbemorefrequent,withagreaterchanceofaddressingpatients’concer
8、nsinatimelymanner,tailoringtreatmentandultimatelyimprovingadherence.Informationandcommunicationtechnologies —ESC2013Manynewwaysbywhichhealthcareteamscancommunicatewithpatients,withthetheoreticaladvantageoftimelyandeffectiveadjust
