以WHO PEN为基础的宁夏农村慢性病干预项目评价研究

发布时间：2018-01-23 22:05

本文关键词： WHO PEN 慢性病评价体系　出处：《宁夏医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景近年来,慢性疾病已逐渐成为们国家居民主要的死因之一。“WHO PEN”项目选择宁夏青铜峡市作为样本地区进行糖尿病和高血压的干预研究,最终探索一套适合宁夏农村地区慢性疾病的干预模式。但其干预效果如何?是否达到WHO PEN干预工具包的最终目标?需要我们从项目的各个环节进行综合分析评价,这对宁夏农村地区慢性病干预模式的建立具有重要意义。目的本研究在对“WHO PEN”项目的管理体制和方案设计的基础上,选择代表性评价指标,建立评价指标体系,按照条件-过程-结果的评价原理对其实施效果进行系统的客观评价,同时将“WHO PEN”项目与国家基本公共卫生服务项目中慢性病的干预相分离,找到两者干预的差距,为宁夏农村地区慢性病防控提供理论基础与实践指导。方法定性分析:现场调查法收集项目实施的基本情况、样本地区管理人员、医务人员和居民的相关资料,德尔菲法筛选、确定最终建立评价指标体系,描述性分析法分析条件、过程和结果指标;定量分析:单因素和多因素logistic回归分析进行慢性病高危因素筛查分析,因子分析法分析项目管理人员和工作人员满意度情况,成本-效果法进行经济学评价,差异分析法对本项目与国家基本公共卫生服务项目进行交叉效果评价。结果1.通过德尔菲法建立“WHO PEN”项目评价指标体系,包括条件、过程、结果3个一级指标;组织管理、项目基线调查、项目实施情况等11个二级指标;内部管理制度、设备、药品、成本效果分析等41个三级指标;设备前后对比情况、高血压相关因素分析等9个四级指标。2.项目成立干预领导小组和专业技术指导组负责项目的具体实施工作;总经费为45.36万元,无违规经费使用,但经费下拨不及时,导致样本地区垫付资金开展项目活动;项目共开展四项培训活动,共培训人员290人;高危因素共筛查4418人;健康教育共宣传5024人,发放宣传资料2.01万份;开展慢性病患者自我管理小组8个,参与患者达610人。3.结果评价:干预前后设备配备情况较好,但由于政策限制,药品总体配备率较低;干预后高血压/糖尿病知识知晓率分别提高到78.48%和79.85%;高危因素筛查发现吸烟、高血压家族史、吸烟、高脂高盐饮食和性别5个指标与血压升高有关,肥胖、糖尿病家族史、吸烟和每日水果摄入量4个指标与血糖升高有关;项目工作人员居民满意度总均分在4.25-4.83之间;因子分析发现整体满意度为3.879,经费协调因子满意度较差;经济学评价发现两病C期均与A期成本效果好,其主要原因由于A期为干预初期,效果较明显;两病排除两项目政策交叉效果后,均为本项目干预效果较好;项目实施效果的影响因素主要有项目管理因素、经费因素、干预技术提供方和需求方因素。建议1.经费拨付应及时,避免项目样本地区卫生院垫付资金开展项目活动;2.提高乡镇卫生院临床服务和公共卫生服务能力,提高卫生资源的合理配置;3.根据地方实际情况,进一步修改基本药品目录;4.慢性病患者自我管理应采用专业视频的形式,呈现为图、文、声并茂,便于理解;5.WHO追加项目资金设计一个WHO PEN慢性病管理信息系统,根据不同人群的不同特点,从筛查、干预治疗、随访及预后每一个过程入手,设计一套适合宁夏农村地区慢性病干预的管理信息系统。6.将适宜技术加入到WHO PEN慢性病的防控与干预中,将本项目中的药品清单与适宜技术的药品结合到一起,更好的为慢病患者提供治疗服务。
[Abstract]:Background: in recent years, chronic disease has gradually become one of the main causes of death. Country residents "intervention study on WHO PEN" project in Ningxia Qingtongxia City as a sample area for diabetes and hypertension, to explore a set of suitable for chronic diseases in Ningxia rural areas of intervention mode. But the effect of intervention? The ultimate goal is to WHO PEN intervention kit? We need to evaluate from all aspects of the project to conduct a comprehensive analysis, the establishment of the intervention of chronic diseases in rural area of Ningxia has important significance. The purpose of this study is based on the design of the management system and the scheme of "WHO PEN" of the project, the selection of representative evaluation indicators, establish evaluation index system according to the objective. The evaluation system for the effect of the implementation of the principle of evaluation process the results of the "WHO PEN" project and the national basic public health service Chronic disease intervention project phase separation, the two find intervention gap, provide theoretical basis and practical guidance for the prevention and control of chronic diseases in rural area of Ningxia. The qualitative analysis method: the basic situation of field investigation to collect the implementation of the project management area, samples and related data of medical staff and residents, the Delphi method to determine the final selection, evaluation the index system, descriptive analysis, process and outcome indicators; quantitative analysis: univariate and multivariate logistic regression analysis was performed to analyze the risk factors of chronic disease screening, factor analysis of project management and staff satisfaction, evaluate the pharmacoeconomic cost-effectiveness method, difference analysis for cross effect evaluation of the project with the national basic public health services. The 1. through the Delphi method to establish "WHO PEN" project evaluation index system, including the condition That process, the results of 3 level indicators; organization management, baseline survey project, the project implementation of 11 level two indexes; the internal management system, equipment, drugs, cost effect analysis of 41 level three indexes; comparison of equipment before and after the 9 level four indexes.2. project related factors analysis of hypertension intervention was established leadership team and professional technical guidance group is responsible for the specific implementation of the project; the total budget is 453 thousand and 600 yuan, no illegal use of funds, but the funds allocated is not timely, resulting in the sample area to advance funds to carry out project activities; the project conducted a total of four training activities, training a total of 290 people 4418 people were screened; risk factors; health education the propaganda of 5024 people, distributed 20 thousand and 100 copies of promotional materials; carry out self management group of 8 patients with chronic disease, to participate in the evaluation results of.3. patients up to 610 people before and after the intervention: equipment is better, but because of policy restrictions, total drug The body is equipped with a low rate; dry rate were increased to 78.48% and 79.85% to know the prognosis of hypertension / diabetes knowledge; risk factor screening found that smoking, smoking, family history, hypertension, high fat and high salt diet and sex 5 indicators associated with the increase of blood pressure, obesity, family history of diabetes, smoking and daily intake of fruits and 4 indicators hyperglycemia; resident satisfaction project staff total score between 4.25-4.83; factor analysis shows that the overall satisfaction was 3.879, funding coordination factors of poor satisfaction; economic evaluation found that two disease C phase with A phase cost effect is good, the main reason for early intervention because of A, the effect is obvious; two cross project policy effect excluding the two disease, were the better effect of intervention in the project; the project implement effect are the main factors of project management factors, financial factors, intervention technology supplier and demand side factors. 1. Allocation of funds should be timely, avoid project sample area hospitals to advance funds to carry out the project activities; 2. township hospital clinical services and public health services, improve the rational allocation of health resources; 3. according to the local actual situation, further modify the basic drug list; 4. patients with chronic disease self management should use the professional video format for presentation map, text, voice and 5.WHO, easy to understand; additional project funding to design a WHO PEN chronic disease management information system, according to the different characteristics of different groups of people, from screening, treatment, follow-up and prognosis of every process of design a chronic disease intervention in Ningxia rural area management information system suitable for.6. technology into the prevention and intervention of chronic disease in WHO PEN, the project in the list of drugs and drug appropriate technology are combined together, the better for patients with chronic disease and provide treatment Medical service.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1

【参考文献】