醫院社區服務站對社區居民身體質量指數與血壓改善的關係

Abstract

背景：公共衛生環境的改善和醫療科技的進步，使國人平均餘命逐年延長，社會結構價值觀的改變，導致我國目前生育率逐年下降，少子化與高齡化對人口結構帶來重大影響，內政部社會暨家庭照護署推動「社區照顧關懷據點」以提倡社區照顧服務，建立連續性之照顧體系，社區力量讓民眾對自身的健康有更多的注意與了解。鑒於社區關懷據點的發展，北部某醫院社區醫學中心運用社區在地資源，以「在地人服務在地人」概念，設立社區健康服務站多年，本研究利用社區健康服務站的數據資料庫，以量化分析結果來說明健康服務站的型態對社區民眾健康管理的影響。 目的與方法：本研究使用北部某醫院社區醫學中心社區健康服務站資料庫2015年至2017年資料，從3年的數據中依照篩選條件，條件一是個案每年至少有2筆量測數據，條件二是個案至少連續2年都有量測數據，同時符合兩個篩選條件的個案共1,770人。接著使用多階層線性迴歸模型，來了解社區健康服務站型態差異對社區個案在身體質量指數BMI與血壓管理的影響。 結果：在BMI維持或改善的部分，女性、國中以上的教育程度、無自陳慢性病者、年齡較大者，對BMI的維持或改善較好；社區服務站的類型上，個案BMI維持或改善的成效在社區大廈類型上，比里辦協會類型的服務站來得更好，但社區大廈類型的服務站對於有慢性病的個案卻不利於BMI的維持或改善。在血壓維持或改善的部分，女性、有志工身分、無自陳慢病者，對血壓的維持或改善較好；在社區服務站的類型上，血壓維持或改善的成效未有顯著的直接效果，但社區大廈類型的服務站對於有慢性病的個案，在血壓維持或改善上，有負向的調節效果。 結論：普遍認為不同組織成立的社區據點性質差異不大，但實證存在脈絡調節效果，對社區居民或慢性病患者健康改善有影響，可做為未來設置據點或設計相關健康促進活動的參考。

Backgrounds: Since the Social and Family Affairs Administration Ministry promotes the 'Community Care Center', where community volunteers provide community care for primary prevention. In view of the spirit of established the community care center, the community medical center department of a study case hospital operated Community Health Stations through cooperated with local organizations and volunteers for many years. The medical resources and health promotion activities of hospital have imported into the communities and collect data continuously. We explore whether the type of Health Stations effects the health improvement of community residents. Materials and Methods: We use the Health Station database from 2015 to 2017 and to screen cases with conditions of at least 2 years of consecutive visiting health stations and at least 2 measurement data per year. The number of cases is 1,770 people in total. Multi-level linear regression model analysis is performed to understand the relationship between the types of Health Stations and the improvement of body mass index (BMI) and blood pressure in community residents. Results: At the personal level, female are easier to maintain BMI and blood pressure than male. People with chronic diseases are not good at maintaining BMI or blood pressure. Volunteers are more likely to maintain normal blood pressure. It is easier to maintain BMI with above junior high school education level. At the Health Stations level, the residents in the health stations type of community building showed positive results in the maintenance of BMI or blood pressure, but the residents with chronic diseases in same health stations type showed negative results in the maintenance of BMI or blood pressure. Conclusions: Generally, we believed that the nature of the community health center established by different organizations is not very different, but the evidence has a contextual adjustment effect, which has an impact on the health improvement of community residents or patients with chronic diseases. It can be used as a reference for setting up bases or designing related health promotion activities in the future.