A Study On The Vertical Integration Of Chronic Diseases In Rural Areas

Background:With the trend of population aging faster,the grim prevalance of chronic diseases,the reform of rural health service system faced with a new challenge,how to vertically integrated three-tier health net-work,how to provide continuous,coordinated and integrated services for rural residents,has become one of the important tasks of rural health reform in China.Chronic disease care is regarded as the most suitable service,the main service for integration project,the vertical integration of chronic diseases is considered as the basic pathways to improve quality,save cost and a significant way to enhance chronic disease management level.Objective:This study aimed to build theory and analysis framework for chronic disease care vertical integration in rural areas.For the two common chronic diseases,diabetes and hypertension,the study evaluated the status and influence factors of chronic disease care vertical integration,finded the problems and reasons and provided reference for the rural chronic disease care vertical integration strategy.Methods:Based on the methods of literature research,the ICCC framework and SPO model were constructed to build theory and analysis framework.Using multi-stage random sampling in the investigated areas,it effectively completed a total of 3930 patients and 253 medical personnel questionnaire survey.On the basis of the theory and analysis framework,it evaluated the status from the macroscopic policy and institutional analyses,structural element,service process and service results.Logistic regression method was applied to the analysis of the influence factors in medication adherence,chronic disease prevention and control knowledge awareness.Results:(1)Theoretical analysis of the vertical integration of rural chronic diseases:under the guidance of ICCC framework and SPO model,the theory and analysis framework was constructed.(2)Structural elements:Three investigated areas vertical integration was given priority to village and town integration,emphasized the technical guidance of county-level hospitals,preliminary organization,function and service integration,the lack of normative integration.(3)The service providing process:On the whole,the medical personnel familiar with chronic service integration degree was 43.5%.Patients with chronic disease on the frequency of two-way referral,referral information exchange,the frequency of communication,business communication to help patients degree,such as health information platform usage were concentrated in general and better level."In township and county hospital referral links coordination mechanism"(34.4%)and"Township hospital equipped with drugs were less than country hospital"(16.6%)is the most important condition to promote two-way referral.(4)The service providing outcomes:Awareness of knowledge about prevention and control of hypertension was 75.6%(Gaochun 64.8%,Jingjiang 74.6%and Huaiyin 84%),the influencing factors were marital status,educational level and different regions;88.2%of hypertension patients’ medication adherence was better(Gaochun 92.9%,Jingjiang 92.6%and Huaiyin 79%),the influence factors was different regions and awareness of knowledge about prevention and control.Awareness of knowledge about prevention and control of diabetes was 61.3%(Gaochun 57.1%,Jingjiang 64.7%and Huaiyin 62.6%),influencing factors were gender,marital status and educational level;90.6%of diabetes patients’medication adherence was better(Gaochun 94.3%,Jingjiang 95.3%and Huaiyin 82.9%),the influence factors were regions and awareness of knowledge about prevention and control.Patients with two levels of township and village doctors in the cooperation satisfaction was 48.9%,two levels of county and townshio doctors in the cooperation satisfaction was 28.9%,and patients’ treatment effect of satisfaction was 59.8%.Suggestions:(1)Further improve the theories and analysis framework and build a system for prevention and control chronic disease in rural areas.(2)Play a full role of the professional and technical county-level hospitals and set up a country-township-village chronic care team.(3)Strengthen professional knowledge training,communication between three-level medical institutions doctors,improve the ability of township-village two levels doctors’ chronic disease management.(4)Establish and prefect the incentive mechanism,improve the quality of doctor participation enthusiasm and integration services.