遵义市红花岗慢性非传染性疾病社区健康管理的评估研究

发布时间：2018-07-29 08:01

【摘要】：目的:通过定量研究和定性研究相结合的方法,从基层医疗机构供方和慢性病患者需方的角度,了解遵义市慢性病健康管理服务开展的现状和需求,为该地区完善慢性病健康管理服务提供循证决策依据。方法:采用分层随机抽样方法,随机抽取具有代表性的遵义市红花岗区8个基层医疗机构作为研究地点。通过问卷调查了解慢性病人的一般情况、行为生活方式、健康状况以及对慢性病健康管理知晓、利用、评价情况。通过目的抽样方法,对遵义市疾控中心分管慢性病健康管理的领导及所属8个基层医疗机构分管公共卫生的院长或主任和慢性病健康管理卫生服务人员进行个人深入访谈,了解慢性病健康管理的服务模式、服务效果、软硬件条件、存在的问题及影响因素等。调查数据采用Epidata3.1软件建立数据库,使用spss17.0统计软件进行分析,并运用卡方检验和二分类logistic回归分析探索影响慢性病发病的相关因素。所有定性资料采用国际上普遍使用的框架分析方法(Thematic Framework)对资料进行整理和分析。结果:1.遵义市基层医疗机构慢性病健康管理开展的现状调查发现,(1)在卫生服务提供方方面,基层医疗机构卫生服务人员大多数为女性,专业多为护理专业,职称多为初级职称;大多数(7/8)被调查的基层医疗机构都按照《2015年版国家基本公共卫生规范》实施了慢性病健康管理服务的模式和流程;个人深入访谈调查显示,慢性病健康管理随访评估和体检的利用是最好的,大多数(5/8)的社区认为分类干预的利用最差。慢性病患者对慢性病健康管理项目的满意度都比较高。基层医疗机构改进慢性病健康管理的策略主要有:在小区贴宣传单,增加检查项目,给居民免费发放药品。慢性病健康管理存在的问题:慢性病健康管理本身的原因;人力资源匮乏;设备不足,药品单一缺乏;国家财政经费投入力度不够;多部门合作不协调;考核方面的问题。(2)对慢性病患者问卷调查结果表明,居民对基本公共卫生服务的知晓、利用、满意情况总体比较好,高血压的随访评估和分类干预的知晓、利用、满意度情况偏低,年龄、居住地、职业是高血压筛查知晓的相关因素,城市户口居民的高血压筛查知晓率高于农村户口的居民(P0.05),年龄是高血压健康体检知晓的相关因素,50-60岁的居民对高血压健康体检的知晓高于50岁的居民(P0.05)。年龄是高血压健康体检利用的相关因素,50-60岁的居民对高血压健康体检的利用高于50岁的居民(P0.05),年龄、调查社区、居住地、职业是糖尿病筛查知晓的相关因素,50岁的居民对糖尿病筛查的知晓高于50-60、60-70岁的居民(P0.05),城市居民对糖尿病筛查的知晓高于农村居民(P0.05),年龄、居住地、婚姻状况是糖尿病筛查利用的相关因素,50-60岁的居民糖尿病筛查的利用高于50、60-70岁的居民(P0.05)。2.遵义市基层医疗机构慢性病健康管理开展的需求评估调查表明,(1)慢性病患病负担重,该人群患有10种NCDs,其中57.6%的被调查者患有两种以上的NCDs,患病率从高到低依次为高血压(54.6%),糖尿病(20.1%),血脂异常(13.4%),冠心病(11.7%),慢性支气管炎(8.4%),骨质疏松(5.7%),脑卒中(3.5%),肥胖(2.7%),肺气肿(1.5%),慢阻肺(0.7%);调查发现行为生活方式有待改进,被调查者中,36.1%的人缺乏运动,吸烟率为16.1%,饮酒率为7.9%,18.3%的人睡眠时间小于5小时,40.5%的人食用蔬菜不足300克,12%的人经常食用甜食,16.1%的人口味偏咸。(2)通过个人深入访谈调查发现,除了高血压和糖尿病,还有以下的疾病需要管理起来:冠心病、脑梗塞、心肌梗塞、高血脂,虽然慢性病健康管理卫生服务人员对患者进行了行为生活方式的指导,但仍然存在不良生活方式和饮食习惯,需要优先解决的健康问题是:体检项目需要增加,随访评估和分类干预项目应规范执行,卫生服务人员的专业能力需要提高。在可利用于慢性病健康管理的卫生资源方面,卫生服务人员希望基层医疗机构能够和医保、社保联合起来,双向转诊制度要切实实施起来,希望政府媒体、街道、居委会参与宣传活动。结论:1.基层医疗机构实施慢性病健康管理卫生服务的能力不足,有基层医疗机构没有完全按照基本公共卫生服务规范实施。2.国家对社区慢性病健康管理宣传不到位,居民对社区慢性病健康管理认识不足。3.调查地区居民的慢性病负担较重,该地区基本公共卫生项目中慢性病管理的疾病应该除糖尿病和高血压外,应逐渐扩充,将血脂异常、冠心病等纳入健康管理。4.生活方式中应加强对运动、睡眠、吸烟饮酒及蔬菜摄入不足、盐和糖控制的干预和指导。5.基层医疗机构开展慢性病健康管理还面临着项目本身要求的不合理,居民健康意识不高,人力物力缺乏,国家经费投入不足,多部门合作不协调的挑战。
[Abstract]:Objective: through the combination of quantitative and qualitative research methods, from the point of view of the supply side of the basic medical institutions and the demand side of the patients with chronic diseases, the present situation and demand of the health management service of chronic diseases in Zunyi are understood, and the evidence-based decision basis is provided for the improvement of the health management service of chronic diseases in this area. 8 grass-roots medical institutions in Zunyi red granite district were selected as the research sites. Through questionnaire survey, the general situation, behavior life style, health status, awareness, utilization and evaluation of chronic disease health management were investigated. The chronic disease health of Zunyi CDC was divided by the purpose sampling method. Management leaders and 8 grass-roots medical institutions in charge of public health director or director and chronic health management health service personnel to conduct personal in-depth interviews to understand the service mode of chronic disease health management, service effect, software and hardware conditions, existing problems and influencing factors. The survey data are established by Epidata3.1 software. According to the library, the SPSS17.0 statistical software was used to analyze, and the related factors affecting the chronic disease were explored by chi square test and two classification logistic regression analysis. All qualitative data were analyzed by the international general framework analysis (Thematic Framework) method. Results: 1. the grass-roots medical institutions in Zunyi were slow. The investigation of the status of STD health management found that (1) in the health service provider, most of the health service personnel in the grass-roots medical institutions are women, the major are nursing specialties, and most of the professional titles are primary titles; most of the primary medical institutions investigated in 7/8 have implemented chronic diseases according to the national basic public health norms of the <2015 edition. The model and process of health management service; personal in-depth interview survey showed that the health management follow-up assessment and the use of physical examination were the best. Most of the (5/8) community considered the worst use of classified intervention. The chronic disease patients were satisfied with the chronic disease health management projects. The basic medical institutions improved the chronic disease health. The strategy of management mainly include: putting up the Publicity sheet in the District, increasing the inspection items and giving the residents free medicine. The problems of the chronic disease health management: the cause of the chronic disease health management itself; the lack of human resources; the lack of equipment and the single drug; the state financial expenditure is not enough; the multi department cooperation is incompatible; the assessment aspects are not coordinated. (2) the questionnaire survey of the patients with chronic diseases showed that the residents' awareness, utilization and satisfaction of basic public health services were generally better, the follow-up evaluation of hypertension and the awareness of classified intervention, utilization, low satisfaction, age, residence and occupation were the related factors of the awareness of hypertension screening, and the hypertension of urban household residents The awareness rate of screening was higher than that of rural residents (P0.05). Age was a related factor for health examination of hypertension. The awareness of health examination for hypertension was higher than that of 50 year old residents (P0.05). Age was the related factor of health examination for hypertension, and the health examination of hypertension was higher than 50 years old for the residents of 50-60 years old. People (P0.05), age, investigation community, residence, occupation are the related factors of the awareness of diabetes screening. The awareness of diabetes screening for 50 year old residents is higher than that of 50-60,60-70 year old residents (P0.05). The awareness of diabetes screening in urban residents is higher than that of rural residents (P0.05), age, residence, and marital status are related factors for the use of diabetes screening. The use of diabetes screening for 50-60 year old residents was higher than that of 50,60-70 years old residents (P0.05).2. Zunyi grass-roots medical institutions' chronic disease health management. (1) the burden of chronic disease was heavy, the population had 10 kinds of NCDs, of which 57.6% of the respondents had more than two NCDs, and the prevalence rate was higher from high to low. Blood pressure (54.6%), diabetes (20.1%), dyslipidemia (13.4%), coronary heart disease (11.7%), chronic bronchitis (8.4%), osteoporosis (5.7%), cerebral apoplexy (3.5%), obesity (2.7%), emphysema (1.5%), and slow resistance lung (0.7%); the investigation found that the way of living living needs to be improved, among the respondents, 36.1% people were lack of exercise, smoking rate 16.1%, drinking rate 7.9%, 18.3% People sleep less than 5 hours, 40.5% of the people who eat vegetables less than 300 grams, 12% of the people often eat sweet food, 16.1% people taste salty. (2) through personal in-depth interview survey found that, in addition to hypertension and diabetes, and the following diseases need to be managed: coronary heart disease, cerebral infarction, myocardial infarction, hyperlipidemia, although chronic disease health management guard Health service personnel guide the patient's behavior lifestyle, but there is still a bad lifestyle and eating habits. The health problems that need to be given priority are: medical items need to be increased, follow-up evaluation and classification intervention should be standardized, and the professional ability of health service personnel needs to be improved. With regard to the management of health resources, health service personnel hope that grass-roots medical institutions can be combined with medical insurance and social security, and the two-way referral system should be implemented effectively. It is hoped that the government media, the streets and the neighborhood committees should participate in publicity activities. Conclusion: 1. the basic medical institutions of the grass-roots medical institutions have insufficient ability to implement health services for chronic diseases and health services, and have grass-roots medical machines. The health management of the community chronic diseases is not fully implemented according to the basic public health service standards, and the residents are less aware of the chronic diseases in the community. The chronic disease burden of the residents in the area of the community chronic disease management is less than.3., and the chronic disease management in the basic public health projects in this area should be divided into diabetes and hypertension. It should be expanded gradually, the blood lipid abnormality, coronary heart disease and so on should be incorporated into the health management.4. lifestyle. It is necessary to strengthen the exercise, sleep, smoking and drinking and the insufficient intake of vegetables. The intervention and guidance of salt and sugar control and guidance for the.5. grass-roots medical institutions to carry out the health management of chronic diseases is still facing the unreasonable requirements of the project, the health consciousness of the residents is not high, and the human and materials are not high. Lack of power, insufficient investment from the state, and uncoordinated multi sectoral cooperation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.61

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