关键词: 高血压, 慢性病, 家庭医生签约服务, 健康管理, 病人参与, 患者参与, 影响因素分析

Abstract: Background　At present，in the health management of chronic diseases at the grass-roots level，the overall participation of patients is not high or they are passive（or even forced）to accept health management，and the quality of management is unsatisfactory.Objective　To explore the influencing factors of community hypertension contract patients participating in the chronic disease health management，so as to provide reference for adjusting the health management service means and activating the patients' participation in health management intervention pathway in the next stage of family doctor contract chronic disease health management work，so as to improve the dynamic and potential of patients' participation in health management and enhance the quality of chronic disease management in primary medical institutions.Methods　From September 2018 to March 2019，three comparable institutions were selected from 13 community health service centers in Wuhou District of Chengdu City by stratified sampling method，namely Jinyang，huonan and Huaxing community health service centers.In the system of hypertension contract patients，120 patients were randomly selected according to the number of patients' files.The self-made Questionnaire about the Current Situation of Hypertension Contract Patients Participating in Chronic Disease Health Management and Influencing Factors was used to investigate the respondents.The questionnaire mainly includes the basic information of hypertension contract patients and the possible influencing factors of patients' participation in chronic disease health management.Results　A total of 360 questionnaires were sent out and 349 effective questionnaires were recovered，with an effective recovery rate of 96.9%.There was no significant difference in the willingness of patients of different genders to participate in chronic disease health management（P>0.05）.There were statistically significant differences in the willingness of patients with different age，course of hypertension，marital status，living style，family per capita monthly income，children's situation，special family situation，hypertension diagnosis and classification，current work status，anxiety level，situation of health bulletin boards in the community，situation of health lectures in the community，situation of health education leaflets received by patients，situation of theme parks/streets in the jurisdiction，situation of fitness rooms or sports venues in the jurisdiction，awareness of hypertension，health satisfaction and hypertension treatment expectations to participate in chronic disease health management（P<0.05）.Conclusion　The influencing factors of hypertension contract patients' participation in chronic disease health management are age，course of hypertension，diagnosis and grading of hypertension，current working condition，anxiety level，personal and family factors（marital status，living style，monthly income per capita of family，children's situation，special family situation），community health supporting factors（health propaganda column in the community，health promotion in the community），health lectures，health education leaflets received by patients，theme parks/streets in the jurisdiction，fitness rooms or sports venues in the jurisdiction，personal health literacy level（awareness of hypertension，health satisfaction，hypertension treatment expectations）.In order to activate the initiative of patients and improve the quality of chronic disease management，on the one hand，basic medical institutions need to improve the health literacy of patients by health education，on the other hand，they need the support of all sectors of society，including social security，community construction and medical service delivery system.

Key words: Hypertension, Chronic disease, Contracted services of family doctors, Health management, Patient participation, Patient engagement, Root cause analysis