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우리나라 農村 保健支所에서 高血壓患者의 追求管理 方案 및 그 效果에 關한 硏究
韓聖鉉,金琅昊,李成秀 순천향대학교 1987 논문집 Vol.10 No.2
As a follow-up of the case-control study of some risk factors and status of hypertension control in rural community undertaken in May 1985, a brief assessment survey was carried out in May 1987 in order to evaluate the effectiveness of a special hypertension clinic set up at a health sub-center in Eumseong community for one year period, beginning from April 1986. The objectives of this paper were : (1) To describe a hypertension control model designed for primary care at health sub-center level (2) To present the results of follow-게 care of 39% of hypertension for one year in terms of the change in health indicator(BP level) and the factors related to compliance & non-compliance with prescribed regimen. For this study, data was obtained from 24 hypertension patients diagnosed in the previous study, dividing them into two groups : 42% as the compliance group(C-group) and 58% as the noncomplance group(NC-group). In comparing the two groups, the following results were obtained : 1. There were some difference between the two groups. In their characteristics : For example, (a) in sex composition, C-group was consisted of more female than NC-group(60% vs 50%) (b) C-group had shorter history of hypertension than NC group : the proportion of patients under 4 years group(60% vs 36%) 2. During one year period, 24 sessions of special hypertension clinics were operated at HSC. But the mean number of visits of C-group was 21.9, while NC group had 5.3 visits. 3. Knowledge & attitude toward the needs of hypertension treatment were not different between both groups. Also there were less appreciation on the prescribed duration of care to comply in both groups. 4. C-group had expressed their reliance on the treatment at the special clinic services at HSC, but NC-group *) This investiation was surpported by 1986 research grant of Soonchunhyang University. O.K. also partially sup ported by the GTZ grant. had less relied on the special clinic services at HSC and more prefered to the clinic services of the hospital. But there patients attended hospital were not referred back to HSC. 5. Main reason for compliance of C-group was their concern to prevent from stroke attack and other CV diseases. The reasons for NC-group were mainly due to (1) Geographical in accessibility, (2) Economic problems to pay, (3) Less satisfaction on progress in treatment. 6. As a results of this program in average level of BP, it was found that an average BP of C-group were decreased from 187.6㎜Hg in systolic BP and from 112.2㎜Hg to 103.4㎜Hg in diastolic BP. But, the same of NC-group increased from 169.1㎜Hg to 176.0㎜Hg in systolic & form 100.0㎜Hg to 102.3㎜Hg in diastolic BP. While it is too early to claim the success of special clinic program for hypertension control at primary care(HSC) level, this assessment survey led us a tentative conclusion that public doctor assigned at health sub-center can reasonably manage the hypetension control program if there are some support to overcome clients problems in economic & geographic accessibility and if patients adequately comply with the each special clinic sessions at HSC. In order to further strengthen the hypertension control program at primary care level, the following recommendation can be made ; (1) A set of portable EKG instrument should be equipped at health sub-center when public physicians wish to initate the community-based hypetension control program. (2) Taking into account the size of population & geographical area of each health sub-center(or township), and their work load, the HSC can inititate the H.C. program, starting from the accesible villages near HSC where & when their villages wish to participate in the program. (3) To formulate an effective community-based hypertension control program, there is a need of systematic referral system between HSC(primary) & Hospital(secondary), linking the available health resources in the community(e.g. VHW-CHP-HSC-GP-Hospital) as now being developed by the Eumseong CH project.
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