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The Bureau of National Health Insurance (NHI) has implemented Integrated Delivery Systems (IDS) in all the mountain villages since 1996, but the mortality rate among aboriginal people remains high. Hypertension was the most important and frequent diagnosis in the OPD records of Wanrong and Zhouxi IDS service, also was the first medical expenditure in 2010. Hypertension and its related diseases such as stroke and coronary heart disease were in the list of ten leading causes of mortality for several years. Although most of the investigations concluded that the residents were agreed that IDS being helpful to the doctor consultation accessibility, saving money and time, but the treatment result of hypertension was not satisfied. The reasons of poor therapeutic effects of hypertension treatment include pharmacological and non-pharmacological factors, the pharmacological factor is non-adherence to medications, and the non-pharmacological factor is un-healthy lifestyle. Lalonde (1974) indicated that the reasons of most diseases and deaths were related to lifestyle. The majority people lived in the area of Wanrong and Zhouxi are aborigines, they had characteristics of higher BMI, alcohol consumption, betel nuts chewing and some special diet, it might be worthy to investigate the associations between these lifestyle factors and high prevalence of hypertension.
Our study population is hypertension cases from outpatient of IDS, we had investigated 291 cases who came to OPD for hypertension treatment from 2011 July to Dec 31th, by telephone and made appointment, 198 participates had completed a structured questionnaire including items of sociodemographic factors, adherence to medications and lifestyle behavior. We also review the medical records of medicine
regimen, attendance to appointments. Our result revealed that the control of hypertension and the extent of adherence to medications were strong related (Chi square=19.281, P=0.000 ) The control of blood pressure also had correlations to healthy lifestyle modifications (Chi square=7.247, P=0.027). But there was no correlations between adherence to medications and healthy lifestyle modifications (Chi square=2.948, P=0.567) . We found that having a job (Chi square=8.757, P=0.034) size of BMI (Chi square=7.895, P=0.019) and betel nuts chewing (Chi square=16.074, P=0.041) all had correlations with the behavior of adherence to medications; The factors which had correlations to adherence of lifestyle include had a job (Chi square=8.646, P=0.013), BMI 27(Chi square=7. 580, P=0.023) , and had family history of hypertension (Chi square=17.713, P=0.001). We concluded that quit betel nut chewing, body weight reduction and a stable job could increase the effectiveness of blood pressure control by enhancing the adherence of medication and lifestyle modification. More detailed introduction and explanation of the hypertensive disease and drugs used, might also improve the effectiveness of blood pressure control through better understanding and cooperation.