Study Of Carrying Out Health Management In Rural Community Health Services

In the 21st century, with economic development, improving of people's living standards and per capita life expectancy, the rate of the national's Health risk factors continues to rise, Lifestyle diseases occur in advance. The challenge of "Old before getting rich" becomes more acute; and health problems of farmers are serious. As a new concept of health services, Health Management is significant for health services for rural communities. Health Management and community health services are mutually promotion and complementary. With the actual situation of China and the status of community health services in rural areas, to carry out health services in rural communities in the implementation of health management, and provide a reference model for Innovative content and community of health services in rural communities.1 PurposeUnderstand the health status of rural residents and the main risk factors of Shaoxing City, grasp the status of community health services in rural areas, discuss the need to implement health management, feasibility and appropriate technology for health services in rural communities, give a precise basis for governments at all levels to develop control measures and launch a comprehensive rural health management project.2 Methods2.1 The baseline survey2.1.1 Personal Health Information SurveyWith the physical examination, the famers complete personal health information questionnaire, to collect daily living, disease history, family history, laboratory blood lipids, blood glucose testing, smoking, alcohol consumption, high salt diet, lack of exercise and other health risk factors and disease distribution Prevention knowledge and so on.2.1.2 Physical measurementsIncluding height, weight, waist circumference, blood pressure, heart rate measurements.2.1.3 health habits, health knowledge and health management needs of the investigationQuestionnaire prepared by questionnaire investigation.2.2 The establishment of health recordsAccording to farmers and baseline physical examination findings, hand entered into the computer, to establish the community residents personal and family health records.2.3 The evaluation and prediction of health risk factorsAccording to the results of the baseline survey, according to "Chinese Hypertension Prevention Guide" and "Community Hypertension Intervention information management standards", make the risk stratification of patients with hypertension and blood pressure classification, divide the observed population into the general population, high-risk groups and Disease population, according to health management requirements, diagnosis the community health, analyze the population health risk factors and existing health problems, make intervention recommendations.2.4 health management and health intervention2.4.1 ManagementDoctors responsibility set up the community health management teams in rural communities, according to medical management of each community by 1000-1500 under the jurisdiction of community residents, according to both the principle of division of labor and cooperation, implement personal responsibility.2.4.2 Content ManagementCommunity blood pressure, obesity, monitoring; life behavior guidance, risk factor intervention, standard treatment of hypertension and other diseases, supervision and non-pharmaceutical interventions, face to face health counseling and health education, health education materials paid for individual disease status, on a regular basis Blood pressure, blood glucose monitoring and other projects.2.4.3 managementDoctors responsibility carry out health management activities twice a week, and conduct active follow-up and friends interaction, location and site, time and appointments, the combination of face to face and telephone advice, home service needs to have missed or when meeting people to make an appointment to visit Home visits.2.4.4 Frequency ManagementThe general population health monitoring once a year, high risk population health monitoring every six months. Disease populations to be focused on hypertension, stratified by risk level management. Row-level management of low-risk groups, followed up once every three months; in the risk groupⅡ, line management, followed up once every two months; high-risk, very high-risk groups (including diabetes, stroke, cancer and other chronic diseases) underwent three Management, followed up once a month. Doctors responsibility follow up village farmers responsible doctor-home more than once a year.2.4.5 Health EducationVillage blackboard once a month to publicize the window on a quarterly basis, disease prevention and control of a per household promotional materials, health education, one for each prescription, health education materials in patients with hypertension have a copy to the village health units at least once every quarter Education seminars.2.5 Health Management Evaluation after one yearAfter one year follow-up management, to collect intervention results through the personal health information, physical examination.3 Results3.1 The percentage of Undergraduate, tertiary, secondary, secondary school the following in 66 Doctors responsibility (including six rural doctors) is 15%,35%,41%, 9%; the percentage of the beginning and the intermediate professional titles is 71% and 20%, Doctors responsibility assume community responsibility, "Six in One" of the community health services, each responsible for 1000-1500 community residents.3.2 Total Survey 4771, average age 48.7 years, and 650 people over 60 years, accounting for 23.23%.2823 participants, including men,1,135 cases, accounting for 40.21%, females 1,688 cases, accounting for 57.79%.4042 members of rural cooperative medical insurance people, insurance rate 84.72%, total students, businesses and workers insurance, the insured rate is 95% or more. Insured medical examination rate of 69.84% on average, and cultural levels of primary and junior high school-based, 43.29% and 57.77% each.3.3 The prevalence of hypertension in rural areas is 28.20%, and the standardized prevalence rate is 24.23%, low, medium, high, very high-risk groups were is 0.63% 55.02%,35.43% and 8.92% of the total number of observations; total prevalence of diabetes rate is 4.07%, and the standardized prevalence rate is 3.36%; awareness of hypertensive patients is 48.99%, medication rate is34.42%, drug control rate is 12.19%.3.4 Four risk factors in rural population, i.e. smoking, drinking, high salt diet and inactivity, each with 24.37% and 31.53%,29.33%,92.07%; low, normal weight, overweight and obesity each with 4.57%,56.15%,30.29%,9.00%, the average overweight rate is 39.28% and abdominal adiposity rate is 32.73%; total lipid abnormality rate is 31.63%.3.5 the order of Knowledge of rural residents disease control rate as follows:general health knowledge 71.33%, prevention and treatment of infectious diseases 67.66%, chronic disease prevention 42.33%, lifestyle 40.33%, the group of 35-59 age is highest; four health behavior formation rate is 60.42%, the formation rate of individual behavior: one person, one towel 80.00%, brush teeth morning and night 42.67%, the right hand 54.67%, wash hands before and after meals 64.33%, the growth rate of the health behaviors of different age goes down with age increase,≥60-year-olds is the lowest.3.6 Rural health resource in the order as follows:television, books, medical staff, seminars, blackboard and radio, friends, look forward to receiving health education model for medical personnel, seminars, books, television, and radio Blackboard,60% of the residents want health information from medical personnel.3.7 Farmers are most concerned about health issues and health care needs in the order: life style, chronic disease prevention, women's health, child health, communicable disease control and aged care. Farmers are most concerned about health care needs in order:facilitate medical treatment, regular medical examinations, disease prevention knowledge, lifestyle guidance, home care and the nearest inspection.3.8 After one year Health Management, hypertension awareness and control rates were 96.72%,60.41% from the pre-intervention 48.99%,12.19%. the law of patients with hypertension medication rate increased to 67.10% from 34.42% before intervention, i the number of intermittent medication and no treatment decreased; health risk factors, lack of high-salt diet and activity groups, respectively, decreased to 21.30% and 73.28% from 29.33% and 92.07% before intervention, smoking and alcohol consumption did not change significantly; the awareness of prevention and treatment of various diseases was significantly improved, health behaviors rates of one person, one towel, and washing hands before and after meals have improved, satisfaction of the residents increased to 91.33%v(274/300) from 80%before the management.4 ConclusionThe prevention and control situation of hypertension, diabetes and other chronic disease of rural residents is grim, the incidence of health risk factors is high, health knowledge, awareness and behavior of the formation is low growth, demand for health increased, it is need to implement health management for health services in rural communities, and has feasibility. Implementation of health management in rural community health services is helpful to improve the resident awareness and knowledge of disease, to control rate of risk factors for the health of residents, to improve Harmonious relations between doctors and patients and the health of the whole population levels.