Research On Effectiveness Of Managing Chronic Diseases And Its Influencing Factors

ObjectiveThe prevalence of chronic disease was increasing by the year in China,the burden of disease was more and more heavily with the increasing prevalence.To meet the challenge,Xiamen mode was produced innovatively in Xiamen city.Based on the chronic diseases management in Xiamen,we evaluated the effect of managing chronic diseases from self-management behavior,quality of life and community health services utilization.At the same time,the influencing factors and the indirect and direct effect were explored in our study.The results of our study provided vital preference in carrying out chronic diseases project,preventing the prevalence of chronic diseases,and promoting the effective referral between hospitals and community health centers.MethodThere were 5 community health centers in our study randomly selected in 38 community health centers in Xiamen.The patients were selected to entry the study randomly according to the patients’ identity number in health care system.The patients were diagnosed with hypertension or type-2 diabetes.The face-to-face interview was conducted in collecting patients’ information.The questionnaire composed of basic patients’ characteristics,self-management behaviors,quality of life and health services utilization.The quality control was conducted by double-people data entry.The missing data was complete by multiple imputation.The data analysis in our study was made in SAS,R,Mplus and other software.The quantitative data was described by frequency and ratio.Chi-square test was used to compare the differences among different groups.The quantitative variables were described by mean and standard deviation.The mean differences were analyzed by ANOVA and Wilcoxon test.The independent variables were classified into personal characteristics,personal behaviors,interpersonal factors,community and policy factors based on social ecological model.The ordinal logistic regression was used to explore the influencing factors of self-management behaviors.The log linear model was conducted to explore the impacts of quality of life.The multiple generalized linear mixed model was used to examine the influencing factors of health services utilization.The path analysis methods were used to explore the direct and indirect effect of self-management and quality of life as well as health services utilization.ResultsMost of the patients in our sample were the elderly and female,26.02%of patients lived with complication and 60%of patients self-reported with moderate or lower health status.In personal behaviors,the prevalence of smoking and drinking was closely to 20%and 59%of patients slept generally or worse in the past.In interpersonal levels,the patients who marred or were with lower education account for most of the sample.48.6%of patients lived with family income from 2000 yuan to 4000 yuan.The patients were from 5 community health centers averagely.In policy levels,5.2%of patients joined Xiamen mode and 93%of patients were insured by Urban Employee Basic Medical Insurance or Urban Resident Basic Medical Insurance.The results of univariate analysis demonstrated that the effect of diseases management varied in different social ecological factors.The results in self-management analysis revealed that the patients who were old,without complication,without smoking,good sleep quality and had higher economic income showed better self-management level(χ2=14.15,P<0.001;χ2=4.45,P=0.035;χ2=13.06,P<0.001;χ2=5.69,P=0.017;χ2=7.75,P=0.005).There were significantly statistic differences in self-management among different community health centers(x2=31.04,P<0.001).Patients who joined the Xiamen mode lived with better self-management behavior(χ2=15.16,P=0.002).The results in quality of life showed that the male,the elderly,patients without complication,the smoking,the drinking or the married lived with higher quality of life(P<0.05).The results in health services utilization revealed that patients with higher income or joined Xiamen mode or insurance were more likely to utilize health services(χ2=19.22,P<0.001;χ2=21.57,P<0.001;χ2=21.42,P<0.001).The patients with complication,higher income,joining Xiamen mode and insurance had more frequency of utilizing health services(P<00.01).The patients with complication,bad self-report health,bad sleep quality,joining Xiamen mode or insurance spent more money in curing diseases(t=-5.14,P<0.001;F=13.77,P<0.001;F=4.47,P<0.012;t=2.70,P=0.007;F=5.91,P<0.001).The ordinal logistic regression results revealed that the self-management behavior was influenced by personal characteristics(age,complication,duration and self-reported health),personal behaviors(smoking),interpersonal factors(education),community and policy factors(disease management methods and medical insurance).The quality of life was influenced by personal characteristics(age,BMI and self-reported health),personal behavior(sleep quality),interpersonal factors(marriage and income)and community factors.The policy did not impact the patients’ quality of life.The probability of seeing doctors was influenced by interpersonal factors(education and income),community and policy factors(disease management methods and medical insurance).The personal characteristics and personal behaviors did not impact the probability of seeing doctors.The frequency of visiting doctors was mainly influenced by personal characteristics(complication,self-reported health and duration of diseases),personal factors(education and income),community and policy factors(disease management methods and medical insurance).The personal behaviors variables did not impact the visit frequency.The expenditure of visiting doctors was primarily influenced by interpersonal(income)and policy factors(disease management methods and medical insurance).The results of recursive model demonstrated that BMI and self-reported health were the primary factors of quality of life.The self-management behavior impact quality of life positively and the direct effect was 0.183.The probability of seeing doctors was influenced by community,income and medical insurance importantly.The patients from community B health centers had lower effect(-0.328).The top two was Urban Resident Basic Medical Insurance with 0.324 size of effect.The patients with better self-management behavior were more likely to see doctors,the effect was 0.080.However,the patients with better quality of life showed lower probability of seeing doctors,the effect was 0.158.The frequency of visiting doctors was mainly influenced by Urban Employee Basic Medical Insurance(the effect was 0.251),income more than 4000 yuan(the effect was 0.221)and Urban Resident Basic Medical Insurance as well as disease complication(the effect was 0.205).The patients with better self-management behavior showed higher visit frequency(the effect was 0.072).In contrast,the patients with better quality of life showed lower visit frequency(the effect was-0.194).ConclusionThe management effect of chronic diseases varied in patients with different social ecological variables.The influencing factors of different management effect index varied one another.The self-management behaviors were influenced by personal characteristics,personal behaviors,interpersonal factors,community and policy levels.Policy did not impact the quality of life.The personal characteristics and behaviors were not the factors influencing the probability of seeing doctors in community.The personal behaviors were also not the factors influencing the frequency of visiting doctors in community.The expenditure was mainly influenced by interpersonal and politic factors.The results of path analysis revealed that BMI and self-reported health determined the quality of life and income and medical insurance decided the probability and frequency of visiting doctors.The health inequity existed in different communities.To improve the effect of managing chronic diseases,we should start specific interventions,promote Xiamen mode,enhance health education and self-management behaviors.At the same time,we should decrease health inequity among different communities in conducting a new model.Medical insurance served as an important role in managing chronic diseases.