| BackgroundWith the aging of society, economic development, the accelerated pace of life, the increase of life stress and other factors, the incidence and development of chronic diseases presented a characteristics of high incidence, younger and other features, chronic diseases have become China’s top-one health threat. Chronic diseases’deaths accounted for over85%of the total death constitute in our country, which greatly affected the survival and quality of life of the residents, also increased the social economy and the medical burden. Facing great damage that chronic diseases caused, the prevention and control of chronic diseases have been paid full attention in the domestic and international, the research of technologies of prevention and control of chronic diseases has become a hot issue in domestic and foreign regulatory agencies, also in academic. At present, a complete set of mature theories and policies about techniques and measures for prevention and control of chronic diseases have formed in the world.The government’s attention and years of experience for the prevention and control of chronic diseases provided certain conditions, but also lack of multisectoral cooperation mechanism and macro-policy break through. As a result, studies for chronic diseases’ prevention and control technologies mainly were planned exploratory studies which mostly included projects or pilot studies. Since short duration, easily to lose the sustainability of projects, some effective technologies for prevention and control of chronic diseases were difficult to continue; in community, due to economic interests, services related to medical fees were more provided, then public health services unrelated to medical fees were less or may not provide. As a result, chronic diseases’ prevention and control work were at a standstill in grass-root health organizations, and effective control technical measures for population could not be expanded well.Years of chronic diseases’prevention practice at home and abroad have accumulated a lot of effective intervention measures and experience, amply demonstrated the implementation of effective interventions could reduce or delay chronic diseases or reverse the disease. Both at group level and the individual level, control and reduction of risk factors could bring incredible health improvements. However, the prevention and control of chronic diseases is a long-term work in the health system, and will gradually be integrated into ongoing community health services, make prevention and control technologies of chronic diseases implemented in different populations become the systematic and operational key technologies is particularly important. There were few studies both at home and abroad in this area. Most researches were targeted at specific groups and areas of intervention of a number of measures. There were very few operational researches for promotion of prevention and control technologies of chronic diseases, and lack of researches and analysis of the rationality, operability and manageability of technologies and measures. All the above resulted in lack of theory in the process of promoting these measures, thus wasting manpower and material resources, and inefficient. In addition, an unnecessary waste was caused by the following reasons:lack of comprehensive and systematic analysis and researches of technologies and measures of prevention and control of chronic diseases, implemented in the control of chronic diseases and the promotion of the measures could not be done in mutual collaboration and coordination, and things also could not be done well in systematic control and prevention of chronic diseases, as well as a unreasonable allocation of resources. Facing the challenges and threats of chronic diseases, enhancing optimization for chronic diseases’prevention and control technologies and institutional arrangements has become an urgent task. Thus, how scientifically use of modern science and technologies, the formation of organic combination between health technology sectors and communities, and through technology assessment to regulate technologies of control of chronic diseases, then establishing effective mechanism, improving government and population’s attention and resources support to chronic diseases’ prevention and control, and improving the ability and effects of chronic disease’ control, are the current problem urgently need to solve. Therefore, the study’s main tasks are:(1) definition the connotation and extension of key technologies of prevention and control of chronic diseases;(2) selection and application of the key technologies of prevention and control of chronic diseases;(3) making strategies of prevention and control of chronic diseases scientific and standard.ObjectivesThe general objective of this study is:to explore the hazards of chronic diseases and existing problems in prevention and control technology applications of chronic disease through theoretical and empirical analysis; to screen key technologies in prevention and control of chronic diseases through scientific methods; and to provide theoretical foundation and scientific basis for relevant policy formulation. The specific objectives include:1. to construct theoretical framework for key technologies screening of prevention and control of chronic diseases;2. to build an index system for key technologies screening of prevention and control of chronic diseases, and screen appropriate key technologies for prevention and control of chronic diseases in primary health care institutions;3. to raise systemic strategies for prevention and control technology applications of chronic diseases, orient cost-effective "early prevention and early treatment" model through standard key technologies in prevention and control of chronic diseases, and effectively improve the rational use of health resources, whilst the efficiency in the use of health resources. MethodsThis was a cross-sectional study, including both quantitative and qualitative methods. Quantitative data were collected through the tool of questionnaires, which main contents were rural health service demands and utilization in Jinan of Shandong Province in the year of2009(the population survey), and the development situation of prevention and control technology applications of chronic disease and relevant demands in primary health care institutions in Shandong Province (the institution survey). Qualitative data were collected through the methods of Delphi expert consultation and focus group discussion.Population survey was conducted in3sample counties, Zhangqiu, Changqing and Pingyin, in Jinan, Shandong Province. According to the economic conditions,3townships were randomly selected in each county; and in the same way,6villages were randomly selected in each township and20households in each village. In total, we collected the information of984households and3458respondents. Institution survey was conducted using stratified random sampling method, in accordance with the level of economic development in Shandong Province,6cities, Jinan, Qingdao, Weifang, Linyi, Jining and Heze, were randomly selected; and in the same way,3districts were randomly selected in each city and2-4community health services centers or township hospitals were selected in each district. In total, we collected the information of59primary health care institutions to analyze efficiency and relevant demands of prevention and control technology applications of chronic diseases.In this study, literature research method was used to arrange, integrate and analyze existing literature, in order to fully grasp the technologies involved in the whole process of prevention and control of chronic diseases, establish technology system for prevention and control of chronic diseases, and provide the original screening candidate technologies list and frame design for key technologies screening. Focus group discussions was used to work out the key principles of key technologies screening, potential evaluation indicators and other key issues on key technologies screening, and finalize suitable evaluation indicators. Delphi expert consultation and TOPSIS integrated evaluation methods were used to screen and sort key technologies; and direct inspection score method was used for testing. Data envelopment analysis was used to analyze the efficiency of prevention and control key technology applications of chronic diseases in primary health care institution find out the inefficiency causes and put forward improvement directions.Main Results(1) Basic situation of chronic diseases control system in sample area:Chronic diseases departments are set in different level CDCs in Jinan, however, there are no full time staves that are responsible for the chronic disease prevention and control in some counties. There are big differences among different level CDCs on the amount of fees for chronic diseases control work. For Shizhong county, Tianqiao county and Licheng county, there were no fees for chronic disease control in2011, and it was only4%of the whole expenditures for chronic disease control in Pingyin CDC in2011, but for Huaiyin county, it was up to25.5%.Jinan have carried out a variety of activities about chronic diseases control, for example, in2011, the program of "Building the no smoking city, Pushing legislation on smoking control" which was supported by UNION, and in2012, doing baseline survey for the program of chronic diseases control and the smoke-free environment promoting project, and there were also intervention pilot work about salt reduction and hypertension prevention in the Huaiyin county, Tianqiao county and Zhangqiu county, and there were also screening and intervention activities among stroke risk groups and at the same time we held training meeting about the cancer patient follow-up register and monitoring the causes of death. Clarifying the objectives of chronic disease control work in Jinnan in2015, such as the percent of professional staffs of chronic disease control should be5%among the human resources in different level CDCs. The report rate of causes of death should not be lower than600/100000.(2) Analysis of hazard, prevention and treatment about chronic diseases:the single factor analysis on factors influencing chronic disease morbidity shows that gender, age, marriage, degree of education, occupation, location, dinking or not, joining NCMS or not, receiving free physical examination or not and cooking energy clean or not can affect morbidity of chronic disease obviously among samples. And the multiple-factor analysis shows that among the obvious factors that influence the chronic diseases morbidity which include age, degree of education, income, location and drinking or not, the effect of age was more obvious and the higher degree of education and income are the protect factors of chronic diseases morbidity. And age, marriage, occupation, et al. did not have obvious effect on the chronic disease morbidity.Analysis of chronic diseases patient treatment rate and cost in rural area:cost of chronic disease treatment affects the rate of treatment in rural area. Among the different level of chronic diseases treatment departments, the cost of treatment is least in village clinic, then the township hospital and it is highest in county-level hospitals. The single factor analysis on chronic diseases treatment rate result shows that self-induction health status, the distance of the medical institute, and the disease kinds could affect the chronic diseases treatment rate obviously. And the marriage, degree of culture, occupation, income, county or not, smoking or not and joining NCMS or not had no effect on the treatment rate. Analysis of chronic diseases treatment cost revealed that county or not, self-induction health status, the distance of the medical institute and disease kinds could affect the cost of chronic disease treatment, and there were no obvious effects on the cost of treatment from gender, age, marriage, degree of culture, occupation, income and joining NCMS or not. The multi-factor analysis on the cost of treatment shows that self-induction health status, the distance of the medical institute and disease kinds are the obvious effect factors for the treatment rate, while the county or not, self-induction health status and disease kinds can affect the cost of chronic disease treatment.(3) Screening key technologies on prevention and control of chronic diseases: Through literature review to establish technologies system on prevention and control of chronic diseases. The system was divided into three levels including first level technologies, second level technologies and third level technologies.in accordance with the different groups of people. The first level technologies included technical measures for the whole populations, the high-risk populations and the patients. The Second level technologies included8categories, such as health education, behavioral interventions, medical and health service measures etc. The third level technologies included33categories. Based on the technology system, the research built four-dimensional model of key technologies screening for chronic diseases prevention and control, that is based on controllable risk factors for chronic disease, life cycle of chronic diseases prevention and control, technical level and technical aspects of chronic disease prevention and control, and organically combined the key technologies of the controllable risk factors for chronic disease type and chronic disease prevention and control life cycle stages. The types of controllable risk factors of chronic diseases were the first level index, life cycle of prevention and control on chronic diseases was the second level index, and the technologies of each stage in the life cycle were the third level index. The controllable risk factors for chronic diseases was divided into seven categories, they were hypertension, diabetes, dyslipidemia, overweight or obese, diet unreasonable, lack of physical activity, bad habits (such as smoking, drinking).The research chose the occurrence of risk factors, the hazard of risk factors, and the urgency of the prevention and control capacity on risk factors as the weights of risk factors. Use the critical and effectiveness of chronic diseases prevention and control as the evaluation indexes of the screening on the technologies of chronic diseases prevention and control. At first, evaluate and seqencing the chronic disease prevention and control technologies using the Delphi Expert Consultation Method and TOPSIS analysis according to the classification of controllable risk factors of chronic disease, and screening out50key technologies of7major categories of risk factors, then ultimately worked out15critical importance key technologies for the prevention and control of chronic diseases.(4) Efficiency evaluation on prevention and control technology application of chronic diseases in primary health services:Using the data envelopment analysis (DEA) method to analysis the efficiency of the key technology application on chronic diseases prevention and control in primary health services. Chose the number of healthcare workers, the number of workers engaged in public health services, the financial allocation funds and the number of equipment on prevention and control of chronic diseases as the input index. Chose the number of people participating in chronic disease prevention and control of technical training courses, the number of carrying out chronic disease prevention and control on-site technical guidance Views, the number of brochures on chronic diseases prevention and control, the number of people aged over45who participated in blood glucose monitoring, the number of patients with hypertension who had health records and the number of high risk people with diabetes who had health records as the output index. The results showed that the average efficiency score of critical technology applications on chronic diseases prevention and control in primary health services was low at the level of0.73.374more health records for high-risk individuals with diabetes could be established through efficiency improving, and35percent in the number of disease prevention and control of technical training people,33percent in the number of on-site technical guidance,29percent in the number of chronic disease prevention and control brochures,41percent in the number of glucose monitoring and31percent in the number of health records establishment for patients with hypertension should be increased.Systematic Policies of Technology Applications on Chronic Diseases Prevention and Control(1) Strengthen the mechanisms on chronic diseases prevention and control, including play the role of General Practitioners system, play the role of information construction systems, establish the body-check system in high-risk populations and establish the management and evaluation system on chronic diseases prevention and control in communities.(2) Pay attention to the guiding role of efficiency measures on prevention and control technologies of chronic diseases, including the adjustment of the work idea, the work emphasis and the financing of chronic diseases prevention and control.(3) Establish innovation mechanism of prevention and control technologies on chronic diseases, including establish the mechanism on residents actively prevent and control the risk factors of chronic disease, establish the responsibility mechanism of family physician on prevention and control efficiency on chronic diseases... |
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