高血压患者社区管理模式的研究进展

Research Progress of Community Management Model for Hypertensive Patients

摘要: 随着全球人口老龄化进程加速及生活方式的改变，高血压患病率逐年上升，已成为严重威胁公众健康的重要公共卫生问题。社区作为高血压防控的基本单元，其管理水平直接关系到患者的生活质量。然而，现有的社区高血压管理模式存在患者自我管理意识不足、筛查覆盖率低等问题，限制了管理效果的提升。本文综述了国内外高血压社区管理模式的现状与研究成果，包括家庭医生签约服务、医联体模式、自我管理、“互联网+”健康管理、护士主导管理以及中西医结合等新型模式，结合智能技术应用和药师协作等创新措施。旨在探索更加规范、高效的社区管理策略，为提升基层高血压管理效果提供参考。未来，通过智能化、个性化和规范化的社区管理模式，可进一步改善高血压患者的生活质量，助力慢性病防控体系建设。

Abstract: With the global population aging rapidly and lifestyles undergoing significant changes, the prevalence of hypertension has risen annually, becoming a critical public health issue significantly endangering public health. As the fundamental unit for hypertension prevention and control, community-level management directly influences patient quality of life. However, existing community hypertension management models face challenges such as low patient awareness of self-management and limited screening coverage, hindering effective management improvements. This paper reviews the current status and research findings on community-based hypertension management models both domestically and internationally, focusing on emerging models such as family doctor contracting services, medical association frameworks, self-management strategies, “Internet+”-based health management, nursery-led care, and the integration of traditional Chinese and Western medicine. It also highlights innovative measures like intelligent technology applications and pharmacist collaboration. The aim is to explore more standardized and efficient community management strategies to inform efforts aimed at enhancing the effectiveness of grassroots hypertension management. In the future, by adopting intelligent, personalized, and standardized community management approaches, the quality of life for hypertension patients can be further improved, advancing the development of chronic disease prevention and control systems.