提高老年人高血压知晓率及管理水平：艾德利社区高血压知晓与管理项目（A-CHAMP）的经验教训
Enhancing hypertension awareness and management in the elderly: lessons learned from the Airdrie Community Hypertension Awareness and Management Program (A-CHAMP).
作者信息
Jones Charlotte, Simpson Scot H, Mitchell Diana, Haggarty Susan, Campbell Norman, Then Karen, Lewanczuk Richard Z, Sebaldt Rolf J, Farrell Barbara, Dolovitch Lisa, Kaczorowski Janusz, Chambers Larry W
机构信息
University of Calgary, Calgary, Canada.
出版信息
Can J Cardiol. 2008 Jul;24(7):561-7. doi: 10.1016/s0828-282x(08)70634-2.
BACKGROUND
High blood pressure (BP) is an established and modifiable cardiovascular risk factor; however, awareness and management of this primarily asymptomatic disease remains suboptimal.
OBJECTIVES
The Airdrie Community Hypertension Awareness and Management Program (A-CHAMP) was a community-based BP program for seniors designed to improve public and health care provider awareness and management of hypertension.
METHODS
Volunteer peer health educators (VPHEs) were recruited from the community and trained to manage BP screening sessions in local pharmacies. Airdrie (Alberta) residents 65 years of age and older were invited by their family physicians (FPs) to attend the A-CHAMP sessions. VPHEs identified participants' cardiovascular risk factors, assessed BP with a validated automated device and implemented a management algorithm. Participants with BP higher than 159/99 mmHg were directed to their pharmacists and FPs. All participants with elevated BP at the initial A-CHAMP session were invited to return to a follow-up session four to six months later.
RESULTS
Thirty VPHEs were recruited and trained. All 15 FPs and all six pharmacies in Airdrie participated. VPHEs assessed 406 seniors (approximately 40% of Airdrie seniors) during the three-month program. One hundred forty-eight participants (36.5%) had elevated BP at their first session. Of these, 71% returned for the follow-up session four to six months later. The mean (+/- SD) systolic BP decreased by 16.9+/-17.2 mmHg (P<0.05, n=105) compared with their first visit, and 56% of participants (59 of 105) reached Canadian targets for BP.
CONCLUSIONS
A-CHAMP raised awareness, and identified and managed seniors with hypertension. At follow-up, BP showed statistically and clinically significant and sustained improvement. Participating health care providers and VPHEs indicated that A-CHAMP was effective and feasible in improving awareness and control of hypertension.
背景
高血压是一种已明确且可改变的心血管危险因素；然而，对这种主要无症状疾病的认知和管理仍不尽人意。
目的
艾尔德里社区高血压认知与管理项目（A-CHAMP）是一项针对老年人的社区血压项目，旨在提高公众和医疗服务提供者对高血压的认知及管理水平。
方法
从社区招募志愿者同伴健康教育者（VPHE），并对其进行培训，使其能够在当地药房管理血压筛查环节。艾尔德里（艾伯塔省）65岁及以上居民由其家庭医生邀请参加A-CHAMP环节。VPHE识别参与者的心血管危险因素，使用经过验证的自动设备评估血压，并实施管理算法。血压高于159/99 mmHg的参与者被转介给他们的药剂师和家庭医生。所有在首次A-CHAMP环节血压升高的参与者均被邀请在四至六个月后返回参加随访环节。
结果
招募并培训了30名VPHE。艾尔德里的所有15名家庭医生和所有6家药房均参与其中。在为期三个月的项目中，VPHE评估了406名老年人（约占艾尔德里老年人的40%）。148名参与者（36.5%）在首次环节血压升高。其中，71%的人在四至六个月后返回参加随访环节。与首次就诊相比，平均（±标准差）收缩压下降了16.9±17.2 mmHg（P<0.05，n = 105），56%的参与者（105人中的59人）达到了加拿大的血压目标。
结论
A-CHAMP提高了对高血压的认知，并识别和管理了患有高血压的老年人。在随访中，血压显示出具有统计学意义和临床意义的持续改善。参与的医疗服务提供者和VPHE表示，A-CHAMP在提高高血压的认知和控制方面是有效且可行的。
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