城市门诊医生对家庭血压监测的认知与行为模式调查

The awareness and behavior model of outpatient doctors in cities for home blood pressure monitoring

  • 摘要: 目的了解城市门诊医生对于家庭血压监测(HBPM)的认知情况及行为模式。方法采用便利取样法,自2013年5月至8月在北京、杭州、广州三城市的23家医院和社区卫生中心对门诊医生进行横截面问卷调查。问卷包含年龄、性别等基本信息,涵盖HBPM的价值、意义,诊断高血压的收缩压/舒张压水平,早晚血压测量值的重要性,推荐测量的时机、频度及方法等问题。结果调查共计发放问卷204份,回收194份(应答率95.1%)。男性39人(20.1%),女性155人(79.9%),平均年龄39.7岁。其中来自三级医院医生102人(52.6%),二级医院10人(5.1%),一级医院及社区卫生中心82人(42.3%)。49.5%(96/194)的医生认为HBPM与诊室血压或动态血压监测同等重要,31.4%(61/194)的医生认为HBPM更重要;81.4%(158/194)认为HBPM早、晚血压测量值均重要。95.9%(186/194)的医生认同HBPM可以提高高血压的知晓率,82.5%(160/194)认为HBPM有助于提高诊断的准确性,83.5%(162/194)认为可以提高对患者预后判断的准确性。仅34.0%(66/194)的医生能准确回答HBPM诊断高血压的收缩压/舒张压标准值(≥135/85mm Hg),51.0%(99/194)选择≥140/90mm Hg(诊室高血压诊断标准)。85.6%(166/194)的医生在患者就诊时建议进行HBPM,85.6%(166/194)建议采用上臂式电子血压计,94.8%(184/194)推荐至少每日测量1次,74.2%(144/194)建议起床后和睡觉前测量,43.3%(84/194)建议每次测量2遍,53.6%(104/194)建议测量3遍。32.5%(56/194)建议记录第2、3个读数的平均值,40.7%(79/194)建议记录所有读数的平均值。结论城市门诊医生诊疗中对HBPM的推荐的行为模式基本符合指南与共识,但认知水平仍有待提高。亟需加强教育与培训以改进对血压测量和监测的认知及行为模式。

     

    Abstract: Objective To investigate the awareness and behavior model for home blood pressure monitoring(HBPM)among outpatient doctors in cities. Methods Convenience sampling was used to collect cross-sectional questionnaires of outpatient doctors from 23 hospitals or community-based clinics in Beijing,Hangzhou and Guangzhou from May to August 2013. The questionnaires included age,gender and other basic information and involved the value and significance of HBPM,the cut-points of systolic and diastolic pressure for diagnosis on hypertension,attitude on significance of morning or nocturnal blood pressure values,and time,frequency and methods of measuring. Results A total of 204 questionnaires were delivered during this survey,194 subjects responded(response rate was 95.1%).39(20.1%)were male,155(79.9%)were female. Average age was 39.7years old.102(52.6%)doctors were from tertiary-level hospitals,10(5.1%)from secondary-level hospital and 82(42.3%)from primarylevel hospitals or community-based health care centers. 49.5%(96/194)doctors regarded the equal importance of HBPM and office blood pressure measurement(OBPM)or ambulatory blood pressure monitoring,and 31.4%(61/194)considered HBPM more important;81.4%(158/194)doctors considered the equal importance of HBPM during daytime and night.95.9%(186/194)doctors acknowledged HBPM would help to improve the awareness of hypertension,82.5%(160/194)believed HBPM could raise the accuracy of diagnosis,83.5%(162/194)believed HBPM might help to improve accuracy of prediction of prognosis. Only 34.0%(66/194)doctors could correctly answer the cut-points of systolic blood pressure/diastolic blood pressure(≥135/85 mm Hg)for diagnosis of hypertension by HBPM,and 51.0%(99/194)choose≥140/90 mm Hg(cut-points of OBPM). 85.6%(166/194)doctors recommended HBPM as patients visit,85.6%(166/194)prefer arm-style electronic device,94.8%(184/194)suggested measuring at least once daily,74.2%(144/194)advised measuring after getting up and before sleeping,43.3%(84/194)proposed measuring twice and 53.6%(104/194)proposed measuring three times each time.32.5%(56/194)doctors advised to record the average value of the second and third readings and 40.7%(79/194)doctors recommended to record the mean of all readings. Conclusion The behavior models on HBPM recommendations are accordance to the guidelines and consensus statements,but the level of awareness are still low among outpatient doctors in cities,indicating a compelling need for education and training to improve the awareness and behaviors on blood pressure measurement and monitoring.

     

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