Effect of Intervention Program for Patients with Hypertension Registered in Home Health Care

Abstract

This study represents quasi-experimental researches to compare efficacy of case management between registered hypertensive patients group under the customized visiting health care service and control group. It was performed by using nonequivalent control group pretest-posttest design. The subjects for this study are registered hypertensive patients under the customized visiting health care service in S-city, Gyeonggi-do. There are 53 patients in total; 28 patients who met the criteria were selected in Experimental Group and the rest 25 patients were placed in Control Group. The data collection and case management were carried out for 12 weeks from April to July. Experimental Group had six home visits and two phone calls during the 8-week period and was provided standardized service of 12-week follow up care as well while Control Group had two home visits during the 8-week period, 12-week follow up care and received informative sessions for high blood pressure management with the same material that was also given to Experiment Group. Statistical analyses were performed by SPSS 15.0 Program to see frequency and percentage for general characteristics of the subjects. Chi-square was performed to compare homogeneity verification between Experiment and Control Groups. Weekly differences of blood pressure were analyzed by repeated measures ANOVA. The physiologic index of systolic BP and diastolic BP, changes of total cholesterol, knowledge on self-management of high blood pressure, performance of self-management, and confidence in self-management were calculated before and after intervention program, and the differences between the two groups were analyzed by t-test. The results of the study are as follows: Hypothesis I, “Experimental Group would have a wider range in decline of systolic and diastolic BP before and after intervention than Control Group”, was accepted as there were significant differences of systolic and diastolic BP between the two groups (t=3.201, p=.002, t=2.364, p=.022). Hypothesis II, “Experimental Group would have a wider range in decline of cholesterol before and after intervention than Control Group”, was rejected as there was no significant difference of cholesterol between the two groups (t=1.457, p=.151). Hypothesis III, “Experimental Group would have a wider range in increase of knowledge on high blood pressure before and after intervention than Control Group”, was accepted as there were significant differences of knowledge during Week 1-Week 8 and Week 8-Week 12 between the two groups (t=-3.212, p=.002, t=-2.054, p=.045). Hypothesis IV, “Experimental Group would have a wider range increase of self-management performance before and after intervention than Control Group”, was accepted as there were significant differences during the research period. During Week 1-Week 8 there were significant differences (t=-2.752, p=.008), but there was no significant difference during Week 8-Week 12 (t=-4.892, p=.000). Hypothesis V, “Experimental Group would have a wider range in increase of confidence in self-management before and after intervention than Control Group” was accepted as there were significant differences of confidence in self-management between the two groups during Week 1-Week 8 and Week 8-Week 12 (t=-4.832, p=.000, t=-2.888, p=.006).

본 연구는 맞춤형 방문건강관리사업 대상자로 등록･관리 중인 고혈압환자에 대한 방문간호 중재프로그램의 효과를 대조군과 비교한 비동등성 대조군 전후설계에 의한 유사실험 연구이다. 본 연구의 대상자는 경기도 S시의 맞춤형 방문건강관리사업 대상자 중 고혈압환자로 등록된 대상자로서 대상자 선정기준에 합한 실험군 28명, 대조군 25명으로 총 53명이었다. 자료수집 및 중재기간은 4월부터 7월까지 12주 동안 실시되었으며 실험군인 중재 대상자는 8주 동안 6회의 가정방문과 2회의 전화방문, 12주 추후관리로 구성된 표준화된 서비스를 제공하였고, 대조군에게는 8주 동안 2회 방문, 12주 추후관리로 고혈압 관리에 대한 교육을 실험군과 동일한 교재를 사용하여 교육하였다. 수집된 자료는 SPSS 15.0프로그램을 이용하여 대상자의 일반적인 특성은 빈도와 백분율로 보았으며, 실험군과 대조군의 동질성 검증은 Chi-square로 분석하였다. 주별 혈압 차이는 Repeated Measures ANOVA로 분석하였고, 생리적 지표 수축기혈압, 이완기혈압, 총콜레스테롤의 변화와 자가관리 능력 고혈압에 대한 지식, 자가관리 이행, 자기관리 자신감은 중재프로그램 전･후 차이를 산출한 다음 두 집단 간의 점수 차이로 t-test를 이용하여 분석하였다. 본 연구결과를 요약하면 다음과 같다. 가설 1. “실험군이 대조군에 비해 중재 전･후 수축기혈압과 이완기혈압 감소폭이 보다 클 것이다”에서는 두 집단 간에 수축기혈압과 이완기혈압은 유의한 차이가 있어 지지되었다 (t=3.201, p=.002, t=2.364, p=.022). 가설 2. “실험군이 대조군에 비해 중재 전･후 콜레스테롤의 감소폭이 보다 클 것이다”에서는 두 집단 간에 콜레스테롤은 유의한 차이가 없어 기각되었다 (t=1.457, p=.151). 가설 3. “실험군이 대조군에 비해 중재 전･후 고혈압에 대한 지식 점수 차이가 보다 높아 질 것이다”에서는 두 집단 간에 1주-8주, 8주-12주에서 유의한 차이가 있어 지지되었다 (t=-3.212, p=.002, t=-2.054, p=.045). 가설 4. “실험군은 대조군에 비해 중재 전･후 자가관리 이행 점수 차이가 보다 클 것이다”에서는 두 집단 간에 1주-8주에서는 유의한 차이가 있었으나(t=-2.752, p=.008), 8주-12주에서 유의한 차이가 없었다(t=-1.963, p=.055). 그러나 1주-12주에서는 유의한 차이가 있었으므로 지지되었다 (t=-4.892, p=.000). 가설 5. “실험군이 대조군에 비해 중재 전･후 자가관리 자신감 점수 차이가 보다 클 것이다”에서는 두 집단 간에 1주-8주, 8주-12주에서 유의한 차이가 있어 지지되었다(t=-4.832, p=.000, t=-2.888, p=.006).