농촌의학ㆍ지역보건 (Journal of agricultural medicine and community health)

한국농촌의학지역보건학회 (Korean Society for Rural Medicine and Community Health)
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고혈압·당뇨병 환자의 혈압·혈당 조절에 미치는 의원 기반 만성질환관리사업의 효과

Effects of Chronic Disease Management Based on Clinics for Blood Pressure or Glycemic Control in Patients with Hypertension or Type 2 Diabetes Mellitus

  • 정원 (가천대학교 의학전문대학원 예방의학과) ;
  • 임준 (가천대학교 의학전문대학원 예방의학과) ;
  • 오대규 (가천대학교 의학전문대학원 예방의학과) ;
  • 임정수 (가천대학교 의학전문대학원 예방의학과) ;
  • 고광필 (가천대학교 의학전문대학원 예방의학과) ;
  • 김윤미 (가천대학교 간호학과)
  • Cheong, Won (Department of Preventive Medicine, Graduate School of Medicine, Gachon University) ;
  • Yim, Jun (Department of Preventive Medicine, Graduate School of Medicine, Gachon University) ;
  • Oh, Dae-Kyu (Department of Preventive Medicine, Graduate School of Medicine, Gachon University) ;
  • Im, Jeong-Soo (Department of Preventive Medicine, Graduate School of Medicine, Gachon University) ;
  • Ko, Kwang Pil (Department of Preventive Medicine, Graduate School of Medicine, Gachon University) ;
  • Kim, Yun Mi (Department of Nursing, Gachon University)
  • 투고 : 2013.03.29
  • 심사 : 2013.06.03
  • 발행 : 2013.06.30
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초록

본 연구는 인천시 만성질환관리사업을 통해 고혈압, 당뇨병 환자의 혈압 및 혈당이 조절되었는지를 평가하고자 수행하였다. 2010년 1년 간 참여의원에 등록한 11,501명을 대상으로 인천시 사업의 일환으로 진행된 교육과 필수검사에 따라 혈압과 혈당이 조절되었는지를 1년간의 추적관찰을 통해 분석하였다. 연구 결과 고혈압의 경우 등록 시점에서 혈압 조절이 안 된 군은 1년 후 교육이 혈압조절에 효과가 있는 반면, 등록 시점에서 혈압조절이 잘 된 군은 1년 후 필수검사가 혈압 조절에 효과가 있는 것으로 나타났다. 반면, 당뇨병 환자의 혈당 조절과 교육 및 필수검사와의 관련성은 확인하지 못하였다. 본 연구결과를 통해 향후 고혈압 환자의 효과적인 만성질환 관리를 위해서는 교육과 필수검사의 활성화가 중요하며 이를 위한 적극적인 노력이 필요할 것으로 생각된다.

Objective: This study aimed to examine the effects of chronic disease management program based on clinics for blood pressure control or glycemic control in patients with hypertension or type 2 diabetes mellitus in Incheon. Methods: An observational follow up study was done on 11,501 patients registrated at clinics from January 1st to December 31st, 2010 in Incheon. Experience of education and mandatory laboratory tests were assessed with the registration data and income status was identified by National Health Insurance data. The odds ratio and 95% confidence intervals were derived from logistic regression models. Results: The experience of education has a positive effect for blood pressure control in the non-control group with hypertension at the time of registration (Odds ratio 1.357, confidence intervals: 1.112~1.655). The experience of mandatory laboratory tests has a positive effect for blood pressure control in the control group with hypertension at the time of registration (Odds ratio 1.738, confidence intervals: 1.387~2.178). But the effects of the experience of education and mandatory laboratory test in patients with type 2 diabetes mellitus were not identified. Conclusions: This study revealed the relationship between the experience of education or mandatory laboratory testing and blood pressure control in patients with hypertension.

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참고문헌

  1. Korea Centers for Disease Control & Prevention. Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANESIV-3). Seoul, Ministry of Health & Welfare, 2010, pp.54-56 (Korean)
  2. Franco LJ, Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Comeaux PJ. Prevalence, detection, and control of hypertension in a biethnic community: The San Antonio Heart Study. Am J Epidemiol 1985;121:684-696 https://doi.org/10.1093/aje/121.5.684
  3. Odegard PS, Goo A, Hummel J, Williams KL, Gray SL. Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention. Ann Pharmacother 2005;39(3):433-440 https://doi.org/10.1345/aph.1E438
  4. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH. Implications of small reductions in diastolic blood pressure for primary prevention. Arch Inter Med 1995;155(7):701-709 https://doi.org/10.1001/archinte.1995.00430070053006
  5. Park CM, Chang SM, Jang SH, Lee HJ, Kim CS, Park IB. Analysis of medical costs and health outcomes for hyeprtension and diabetes due to adherence. Seoul, Health Insurance Reviews & Assessment Service, 2010 (Korean)
  6. Lewington S, Clarke R, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360(9349):1903-1913 https://doi.org/10.1016/S0140-6736(02)11911-8
  7. Nine SL, Lakies CL, Jarrett HK, Davis BA. Community-based chronic disease management program for African Americans. Outcomes Manag 2003;7:106-112
  8. Seo YM. A structural model development for health behavior adherence in hypertensive or diabetic patients [dissertation]. Daegue, Kyungpook National University, 1989 (Korean)
  9. Yoo SJ. Effects of abdominal relaxed breathing training and self care education on blood pressure for elderly hypertensives [dissertation]. Seoul, Seoul National University, 2000 (Korean)
  10. Choo HI. Effects of a self-regulation program on blood pressure control and self-care in patient with essential hypertension [dissertation]. Seoul, Yonsei University, 2008 (Korean)
  11. Lee JH. Effect of diabetes self-care management education of type 2 diabetes [dissertation]. Seoul, Yonsei University, 2007 (Korean)
  12. Kim EJ. Effect of diabetic education on the compliance of treatment in outpatients [dissertation]. Iksan, Wonkwang University, 2008 (Korean)
  13. Berg M. Patient education and the physicianpatient relationship. J Fam Pract 1987;24(2): 169-172
  14. Suchman EA. Stages of illness and medical care. Am J Health Hum Behav 1965;6(3): 114-128 https://doi.org/10.2307/2948694
  15. Becker MH, Maiman LA et al. The health belief model and prediction of dietary compliance: a field expetiment. J Health soc Behav 1977;18(4):348-366 https://doi.org/10.2307/2955344
  16. Hong DH, Seo HJ, Kang KH, Kim EJ, Im JS, Oh DK, Yim J. Impact of registration program after hypertensive or diabetic patient detection through community partnership on compliance and blood pressure or blood sugar control. J Agri Med & Community Health 2008;33(3):316-323 (Korean) https://doi.org/10.5393/JAMCH.2008.33.3.316
  17. Yeo JY. A study on environment factors influencing blood pressure control of patients with hypertension [dissertation]. Seoul, Ewha Womans University, 1980 (Korean)
  18. Gnasso TA, Hollis J, Ockene JK, Svendsen K. Smoking cessation and change in diastole blood pressure, body weight, and plasma lipids. Am Prev Med 1991;20(5):602-620 https://doi.org/10.1016/0091-7435(91)90058-C
  19. Midgley JP, Matthew AG, Greenwood CM, Logan AG. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA 1996;275(20):1590-1597 https://doi.org/10.1001/jama.1996.03530440070039
  20. Kim SY. Physician factors affecting the hypertension control rates of hypertensive patients [dissertation]. Seoul, Seoul National University, 2007 (Korean)
  21. Chiu CJ, Wray LA. Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes. Prev Chronic Dis 2010;7(1):1-11
  22. Agardh EE, Ahlbom A, Anderson T, Efendic S, Grill V, Hallqvist J, et al. Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women. Diabetes Care 2003;26(3):719-724 https://doi.org/10.2337/diacare.26.3.719
  23. Ahn HJ, Koo BK, Jung JY, Kwon HR, Kim HJ, Park KS, et al. Bowl-based meal plan versus food exchange-based meal plan for dietary intake control in Korean type 2 diabetic patients. Korean Diabetes J 2009;33(2):155-163 (Korean) https://doi.org/10.4093/kdj.2009.33.2.155
  24. Shiloah E, Witz S, Abramovitch Y, Cohen O, Buchs A, Ramot Y, et al. Effect of acute psychotic stress in nondiabetic subjects on ${\beta}$-cell function and insulin sensitivity. Diabetes Care 2003;26(5):1462-1467 https://doi.org/10.2337/diacare.26.5.1462

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