| (?)We aimed to grasp the ability of diabetes prevention and control, the mode of management, and the effct of diabetes prevention and control in primary health care institutions of China, by means of literature research and field survey. Then we explored the experience and problems, and analyzed the reasons and barriers of districts lacking System Management of diabetes and other chronic diseases. Consequently we tried to put forward specific policy recommendations for constructing mode of management, mechanisms, and support systems to improve the ability of diabetes prevention and control in primary health care institutions of China.MethodsThis study is a combination of qualitative and quantitative research, the specific method including meta-literature, questionnaires, focus group interviews and case studies. Design diabetes management questionnaire by letter reconcile site fill questionnaires, on-site interviews while collecting file system, a summary of readily available information about diabetes management around the current situation and problems, operating modes and mechanisms and the related recommendations and opinions and so on. Around the distinctive patterns and mechanisms of diabetes management case studies, in-depth understanding of the specific mode of diabetes management, working mechanisms and support systems. Application Epidata3.1software for data entry, application the Excel2000SPSS13.0and SAS8.12professional statistical software for statistical analysis. Results1. institution-building. Urban community health service centers and township hospitals, business houses average area of2469.25square meters and2553.56square meters, exceeding the national building standards. Center inpatient beds an average of34.49and bed and an average of5.18. The hospitals inpatient beds an average of24.10and bed and an average of4.93.2. The configuration of human resources for health. Graduate degree in urban community health service center clinicians accounted for2.94%,31.3%undergraduate, the specialist accounting for36.54%, secondary accounted for21.64%, and the rest for the following secondary education, accounting for7.54%. Prevention and care staff education specialist, accounting for42.99%, followed by secondary education, accounting for28.60%,18.17%undergraduate, graduate of0.90%, accounting for9.56%of the following secondary. Nurses’ qualifications in secondary, accounting for45.55%, followed by the specialist, accounting for41.25%, secondary school accounted for6.55%,5.42%undergraduate, postgraduate education accounted for1.23%. Urban community health service center clinicians titles junior titles, accounting for51.58%, followed by intermediate grade, accounting for35.99%,12.43%senior title. Anti-Paul Designation of junior titles, accounting for63.92%, intermediate grade of28.94%senior titles, only1.65%,5.49%titles. Nurse titles junior titles, accounting for71.82%,26.74%intermediate, senior titles of only1.43%. In rural township hospitals, clinicians education specialist and secondary,43.73%and38.92%, respectively, followed by a bachelor’s degree, accounting for12.68%, the rest is secondary degree, stand4.68%. Anti-assurance personnel qualifications to secondary, accounting for48.88%, followed by the specialist, accounting for36.06%, secondary school accounted for11.90%, the undergraduate only3.16%. Nurses’ qualifications in secondary, accounting for58.37%, followed by the specialist, accounting for34.52%, accounting for5.54%of the following secondary, undergraduate only1.57%. Hospitals the clinicians titles to junior titles, accounting for58.82%, followed by intermediate grade, accounting for32.68%,3.47%senior professional titles, titles accounted for5.04%. Prevention and care do not have senior professional titles, which accounted for71.85percent of junior titles, intermediate grade of20.37%,7.78%titles. Nurse’s title to the junior titles, accounting for63.03%, intermediate grade of30.88%, the No Title5:98%, the senior title only0.11%. The above data show that China’s urban and rural primary health services of the health workforce qualifications and title levels are low, the performance of the rural poor in the city.3. Allocation of resources of chronic disease management. Management supporting, with specialized chronic disease management office of the city community health service centers accounted for91.53%of all centers with specialized computer for chronic disease management, computer an average of3.07units.96.61%of the centers of the chronic disease management database (including diabetes database), but the management system stability is not yet ideal, the normal rate of57.89%. With specialized chronic disease management office of township hospitals accounted for64.55%, with specialized chronic disease management computer hospitals accounted for51.82%of hospitals have an average computer1.45. Only32.73%of the hospitals established chronic disease management database (including diabetes database) management system normal operation, the normal rate of97.22%. Township in the city behind, supporting diabetes management than the amount of resources than in the cities.About diabetes detection and treatment work carried out, the survey of urban community health service center can carry out the diabetes testing work, with a blood glucose meter, the other with a biochemical analyzer, the center of the urine dipstick test were79.66%and77.97%.Center to carry out the treatment of diabetes accounts for96.61%. Pharmacy with sulfonylurea agents on insulin secretion, non-sulfonylurea insulin secretagogues, biguanides, glucosidase inhibitors, insulin sensitizers, insulin, hypoglycemic proprietary Chinese medicine centers accounted for84.48%,75.86%,96.55%,60.34%,53.45%,75.86%,79.31%. However, in villages and towns, the diabetes detection hospitals accounted for92.73%. Blood glucose meter, biochemical analyzer, urine dipstick hospitals were90.20%,70.59%and59.80%, respectively. To carry out the treatment of diabetes hospitals accounted for89.91%. Pharmacy with sulfonylurea agents on insulin secretion, non-sulfonylurea insulin secretagogues, biguanides, glucosidase inhibitors, insulin sensitizers, insulin, hypoglycemic proprietary Chinese medicine hospitals accounted for47.57%,11.76%,82.35%,8.82%,15.53%,48.54%,63.11%. The data suggest that the urban community health service centers diabetes detection instruments and drugs for the treatment configuration is complete, with the basic conditions of diabetes treatment. Township hospitals, there are some institutions lack of detection capabilities and treatment drugs, leading to the presence unable to provide the detection and treatment of diabetes.4. Implementation diabetes management. Community health service centers in the city, has been the center of the diabetes community screening accounted for93.22%2009-2010annual average of organized diabetes health education seminars to7.03, most of the centers regularly carry out health education for patients, accounting for98.31%, the center of the regular review of blood glucose or glycated hemoglobin accounted for86.44%of the medication in patients with Steering hospitals accounted for96.61%,accounted for94.92%of the patients and their families health education or skills training center, the establishment of the center of the patient’s health records accounting for100.00%, to carry out the patient home visits98.31%, to carry out health promotion activities center accounted for91.53%of the diabetes community, to carry out the center of the complications monitoring55.1%.32.73%of the hospitals in township hospitals, screening for diabetes community hospitals accounted for65.45%, find out the diabetes.2009-2010, hospitals holds an average of diabetes health education seminars for2.79, regularly carry out health education for patients of hospitals accounted for67.27%of the regular review of blood glucose or glycosylated hemoglobin hospitals accounted for70.91percent of hospitals accounted for medication in patients with Steering hospitals accounted for81.82%of the patients and their families health education or skills training hospitals accounted for82.73%, the creation of patient health records of hospitals accounted for86.36%,81.82%visits to carry out the patient’s family, the diabetes community health promotion activities60.91%, accounted for41.28%of hospitals to carry out the monitoring of complications. More visible, the city’s diabetes management the implementation is superior to the township.5. The model of diabetes management. The main mode of team service model and center (hospital) and Station (room) division of labor. The former includes Center (hospital) participation model, chronic diseases workgroup mode, supervisors chronic disease management model; latter includes center (hospital) led station (room) to assist in the perfect center (hospital) and station (room) co-led the completion formula, the center (hospital) organization, station-led perfect (room) and center (hospital) alone perfect.6. Training of grass-roots medical staff in diabetes and their willingness to prevention and control work. Urban and rural primary care doctors agreed that a small number of existing professional training, lack of content. Community health service centers on diabetes prevention and control work ",52.04%of the respondents said the" general "40.14%" very satisfied "or" satisfied "7.82%" not satisfied "or" very dissatisfied "; township hospitals surveyed,54.82%said" general "37.56%" very satisfied "or" satisfied ",7.61%" not satisfied "or" very dissatisfied ".Conclusions1. China’s primary diabetes prevention network system has been basically established, the overall performance of primary health services to prevent and control diabetes. However, human resources, hardware support and financial investment, it shows the city Diabetes capacity is stronger than in rural areas.2. part of the management is not enough emphasis on the prevention and treatment of diabetes, affecting the Diabetes Prevention enhance the ability of primary health services.3. the grass-roots health personnel overall quality is not high, lack of diabetes prevention and management expertise, performance for the prevention and management of diabetes powerless.4. Diabetes knowledge and skills for primary health services and training lag, the impact of prevention and treatment to enhance the level of medical staff.5. Diabetes no special prevention funding, existing prevention and control work is mainly funded from public health funding, and the amount, support the efforts of diabetes prevention and control work.6. primary diabetes management information system is an uneven trend, but the city is better than in rural areas.7. poor awareness of the health of residents of diabetes prevention and control work participation and cooperation is not strong, diabetes prevention and control work to solve a problem.Innovation and LimitationsThe study is the first nationwide survey of urban and rural diabetes and other chronic disease management to carry out the current situation and analysis of diabetes prevention and control capacity of the primary health services, improvement programs and strategies proposed to further improve China’s grass-roots network of diabetes prevention and management system and improve the control capacity. In this study, systems theory, and resource allocation theory of diabetes prevention and control capacity of China’s grass-roots health services from a broad perspective to explore innovative.Inadequacies and limitations of this study, this study only from the organizational structure and resource allocation point of view of diabetes prevention and control capacity of the primary health services were analyzed, not collected relevant data to reflect the effectiveness of prevention and treatment in the case of existing resources and therefore can not be more precise grasp and improve the ability of primary diabetes for more information. Can further related studies. |
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