Study On The Elderly Health Examination And Its Health-care Continuity In Minhang, Shanghai

BACKGROUND The burden of diseases, especially the chronic diseases, for the elderly increases as the process of aging accelerates. Health management for the elderly was selected as one of the national essential public health management programs, according to the Specification on National Essential Public Health Service published in2009, and regular physical examination for the elderly was required. To play the biggest role of physical examination, the transition between examination and medical service was necessary, because examination can only screen those may be ill. Continuity of care is one of the characteristics of community health service, also one of the core values of the Family Doctor System which is being explored and experimented in our country. Unfortunately, there was almost no empirical research on the continuity of health care or the transition between physical examination and medical service.OBJECTIVE After analyzing the free physical examination programs for the household people who aged more than60in Minhang District of Shanghai, we study the continuity of care for hypertension management with a combination of theoretical research on continuity of care, aiming to help the decision-making to improve the level of hypertension management and deepen the primary health service system.METERIALS AND METHOD The data of free physical examination form year2008to2009for the household elderly in Minhang Shanghai was analyzed to draw abnormal detection rate and population distribution of each program. Systematic random sampling from the participants in the physical examination form year2008to2009was conducted. We derived from the electronic health system of the public hospitals in Minhang district for the diagnosis and prescription data of hypertension from year2009to2012, and selected those who had at least3visits with doctors, to study the organizational and relational continuity. The indicators for organizational continuity were the density of visits to major institution among all visits, and the concentration degree of all institutional visited. The indicator for relational continuity was the concentration degree of all doctors visited. Analysis of transition between physical examination and medical service was based on the diagnosis and prescription data of hypertension from year2009to2012of the former sample population who continued the examination in year2010and2011. We also conducted a telephone survey for the continuity of care and its reasons for these people. In addition, key informant interviews were conducted to supplement the current status of continuity of care.RESULTS Abnormal detection rate for each program was high blood lipids(52.79%), high BMI(45.49%), high blood pressure(42.82%), liver abnormalities (42.18%), abnormal ECG(35.89%), chest X-ray abnormalities(34.00%),high uric acid(32.86%),high blood glucose(25.14%), gallbladder abnormalities(18.57%),kidney abnormalities(13.69%). As for liver abnormalities, the detection rates for fatty liver and schistosoma live disease were also high,14.74%and11.73%, respectively. The detection rate of metabolic syndrome was21.11%.For those who had a high blood pressure at examination but not aware of their condition during the last year, the proportion of those who visited the doctors in half a year after the examination was35.25%. For organizational continuity, mean density of visits to major institution among all visits was0.9824, mean concentration degree of all institutional visited was0.9899, the proportion of those continuing visited one institution was as high as90.36%. Main reason of high organizational continuity was the reasonable distribution of primary health care institutions according to administrative planning and geographical distance. For relational continuity, concentration degree of all doctors visited was0.393(±0.30). Main factors that influence the relational continuity include geographic distance between houses and hospitals, the provision of drugs of hospitals, the flexibility of doctors’ visiting time, quality of service, severity of diseases, residents’ perception of their own health, residents’ cognitive and attitude of continuity of care.CONCLUSION AND SUGGESTIONS The abnormality ratio of examination was high, especially for metabolic examination items. The ratio of residents who visited doctors after being detected hypertension was not ideal enough, the organizational continuity of hypertension management was not bad, but cooperation among institutions and relational continuity was not good enough.More importance should be attached to the prevention and control of hyperlipidemia, hyperuricemia, fatty liver, metabolic syndrome and schistosome liver disease. Improve the service system following the examination to link up public health services and medical services. Strengthen cooperation between and in service agencies. Form a service guideline on continuous service. Pay more attention to continuity of care and do more research on it.