社区卫生中心患者血压控制的相关因素。
Factors Associated With Blood Pressure Control Among Patients in Community Health Centers.
机构信息
Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
出版信息
Am J Prev Med. 2023 May;64(5):631-641. doi: 10.1016/j.amepre.2022.11.002. Epub 2023 Jan 4.
INTRODUCTION
Understanding the multilevel factors associated with controlled blood pressure is important to determine modifiable factors for future interventions, especially among populations living in poverty. This study identified clinically important factors associated with blood pressure control among patients receiving care in community health centers.
METHODS
This study includes 31,089 patients with diagnosed hypertension by 2015 receiving care from 103 community health centers; aged 19-64 years; and with ≥1 yearly visit with ≥1 recorded blood pressure in 2015, 2016, and 2017. Blood pressure control was operationalized as an average of all blood pressure measurements during all the 3 years and categorized as controlled (blood pressure <140/90), partially controlled (mixture of controlled and uncontrolled blood pressure), or never controlled. Multinomial mixed-effects logistic regression models, conducted in 2022, were used to calculate unadjusted ORs and AORs of being in the never- or partially controlled blood pressure groups versus in the always-controlled group.
RESULTS
A total of 50.5% had always controlled, 39.7% had partially controlled, and 9.9% never had controlled blood pressure during the study period. The odds of being partially or never in blood pressure control were higher for patients without continuous insurance (AOR=1.09; 95% CI=1.03, 1.16; AOR=1.18; 95% CI=1.07, 1.30, respectively), with low provider continuity (AOR=1.24; 95% CI=1.15, 1.34; AOR=1.28; 95% CI=1.13, 1.45, respectively), with a recent diagnosis of hypertension (AOR=1.34; 95% CI=1.20, 1.49; AOR=1.19; 95% CI=1.00, 1.42), with inconsistent antihypertensive medications (AOR=1.19; 95% CI=1.11, 1.27; AOR=1.26; 95% CI=1.13, 1.41, respectively), and with fewer blood pressure checks (AOR=2.14; 95% CI=1.97, 2.33; AOR=2.17; 95% CI=1.90, 2.48, respectively) than for their counterparts.
CONCLUSIONS
Efforts targeting continuous and consistent access to care, antihypertensive medications, and regular blood pressure monitoring may improve blood pressure control among populations living in poverty.
简介
了解与控制血压相关的多层次因素对于确定未来干预措施的可调节因素很重要，尤其是在贫困人群中。本研究确定了在社区卫生中心接受护理的患者中与血压控制相关的具有临床意义的因素。
方法
本研究纳入了 2015 年至 103 个社区卫生中心接受治疗的 31089 名被诊断患有高血压的患者；年龄在 19-64 岁之间；在 2015 年、2016 年和 2017 年，每年至少有一次就诊，且至少有一次血压记录。血压控制通过所有 3 年的所有血压测量的平均值来操作，并分为控制（血压<140/90）、部分控制（控制和未控制血压的混合）或从未控制。2022 年进行的多项混合效应逻辑回归模型计算了从未或部分控制血压组与始终控制血压组相比的未调整比值比（OR）和调整比值比（AOR）。
结果
在研究期间，共有 50.5%的患者始终控制血压，39.7%的患者部分控制血压，9.9%的患者从未控制血压。与持续保险（AOR=1.09；95%CI=1.03，1.16；AOR=1.18；95%CI=1.07，1.30）、低提供者连续性（AOR=1.24；95%CI=1.15，1.34；AOR=1.28；95%CI=1.13，1.45）、最近被诊断为高血压（AOR=1.34；95%CI=1.20，1.49；AOR=1.19；95%CI=1.00，1.42）、抗高血压药物不一致（AOR=1.19；95%CI=1.11，1.27；AOR=1.26；95%CI=1.13，1.41）和血压检查次数较少（AOR=2.14；95%CI=1.97，2.33；AOR=2.17；95%CI=1.90，2.48）的患者相比，他们更有可能部分或完全无法控制血压。
结论
针对持续和一致获得医疗护理、抗高血压药物和定期血压监测的努力可能会改善贫困人群的血压控制水平。
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