保健医学研究与实践2023，Vol.20Issue(z2)：35-40,6.DOI:10.11986/j.issn.1673-873X.2023.S2.09
产后妇女高血压社区管理的需要与实施模式的可行性分析
Needs and feasibility analysis of community management for postpartum women with hypertension
摘要
Abstract
Objective To understand the prevalence and correlation factors of hypertension in postpartum women and explore feasible models for linking postpartum care with community hypertension management.Methods A total of 3,297 postpartum women who gave birth in Xuhui District,Shanghai from June 2021 to December 2022 were selected as the study participants.Among them,86 ca-ses were included in the case group,which consisted of women who had a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg(measured on three different days during home visits within one month postpartum)or women who were taking antihypertensive medication and had blood pressure controlled below 140/90 mmHg.The control group was matched 1:1 based on whether the age exceeded 35 years,and consisted of the next visiting postpartum women with normal blood pressure measurements or those who did not take antihypertensive medication.General demographic characteristics,medical history,obstetric history,psycho-logical health,and social support were collected to explore the correlation factors of postpartum hypertension.Twenty personnel,in-cluding district-level and community-level maternal and child health directors,chronic disease directors,postpartum visit personnel,family doctors,and other personnel related to chronic disease services,as well as hypertensive postpartum women,were selected for individual interviews.The internal strengths and weaknesses,external opportunities and challenges of linking postpartum care with community chronic disease management were analyzed from the perspective of the healthcare system.Results The prevalence of post-partum hypertension was 2.60％(86/3297,95％CI=0.020～0.031).The results of multivariate logistic regression analysis showed that women with anxiety(OR=3.619,95％CI=1.283～10.210,P=0.015),a family history of hypertension(OR=5.180,95％CI=2.514～10.673,P＜0.001),and higher pre-pregnancy BMI(OR=3.634,95％CI=1.280～10.621,P=0.018)had an in-creased risk of developing hypertension.The interviewees all believed that long-term management of postpartum hypertension is neces-sary.The well-established maternal and child health and hypertension management work at the community level,as well as the partic-ipation of family doctor teams,laid the foundation for the linkage between community postpartum care services and community hyper-tension management.The two types of services are linked through the community preventive healthcare department,which combines postpartum care and hypertension management functions.However,the low rate of community health service contracts and poor com-pliance of postpartum care service recipients pose challenges to the integrated service model.Currently,the construction of the Chronic Disease Management Center in Shanghai and the implementation of the key population contract policy are conducive to the implementa-tion of the new service model.However,community maternal and child health care and hypertension management belong to two dif-ferent higher-level departments in terms of business,and the lack of interoperability of information systems and inadequate incentive mechanisms for grassroots medical personnel pose challenges to the linkage and implementation of the new model.Conclusion The is-sue of hypertension in postpartum women deserves attention.Under the existing healthcare resource conditions,community health service centers have the feasibility to implement new models for postpartum hypertension management.However,further reforms and improvements are needed for the specific implementation mechanisms.关键词
产后保健/高血压管理/社区卫生服务/妊娠期高血压疾病/危险因素Key words
Postpartum care/Hypertension management/Community health services/Hypertensive disorders in pregnancy/Risk fac-tors分类
医药卫生引用本文复制引用
吴玲霞,潘美巧,杨剑..产后妇女高血压社区管理的需要与实施模式的可行性分析[J].保健医学研究与实践,2023,20(z2):35-40,6.基金项目
上海市徐汇区医学科技资助项目(SHXH202050). （SHXH202050）
