| Among hypertensive patients founded in2007baseline survey, a considerable Hypertensions the most important and popular risk factor of cardiovascular diseases. It estimated that our country’s hypertensive had been approximately410million, on the basis the national health service survey data collected in2008.The life expectancy lost was0.36year and potential life lost were about2.54million life years caused by hypertension in2002; on average, each hypertensive patient died, it would lead to11.4years of "early death"; The medical costs for hypertension was Y31.89billion each year. Hypertension has become an important public health problem. Luxemburg-WHO-Shandong Project on Rural Personnel Training and Chronic Disease Control was funded by the Luxembourg Government and provided technical support by the World Health Organization (WHO). From the year2007to2010, the interventions were implemented in central and western rural eight counties (cities, districts) of Shandong Province. The interventions were about healthy diet, physical activity promotion, tobacco control, blood pressure control and so on. The targets were hypertensive, special population and the whole population. The target of intervention was the whole population,the main intervention were the establish of policy about chronic disease prevention and control, the village health personnel training, health publicity and intervention to the whole population, chronic disease management, chronic disease monitoring, intervention measures exploration of multi-sector prevention and control, chronic disease intervention special events as main task and intervention measures.Main objective:Summarize the comprehensive interventions of chronic disease in eight counties and districts; Analyze the health service utilization of the hypertension aged over25in rural area of Shandong Province from the year2007to2010, to learn the changes of utilization of the hypertensive health service, living behaviors and to evaluate the intervention effects.Methods:Based on the economic status (good, moderate, poor), selected respectively Guangrao County and Shouguang, Yiyuan County and Laicheng District of Laiwu City, and Cangshan County, Ningyang County, Shanghe County, Lingxian eight rural counties (cities, districts) as the project counties. In the light of stratified random sampling principle, each county selected randomly two townships,7villages per township as the baseline group in the year2007; each county selected randomly one project village as the intervention group in the year2010; selected randomly4counties from eight counties, and a non-project village as a control group from the intervention villages and towns. Biennial administrative village sampling, systematic sampling on the basis of the household head roster was proceeded and over25years old resident population as respondents in the extracted household was conducted questionnaire survey. The project also conducted a key informant interview about the project implementation plan, implementation time, the encountered problems and achieved results. Qualitative interviews were generalized and summarized primarily through organizing field notes and recordings. Numerical variable data used the mean and (or) the median to describe, and the categorical variable data used rate, constituent ratio. Adopting independent samples t test to compare two sample means of normal distributional numeric variable data chi-square test to analysis disorder classification data, ranked data and rank sum test to analysis the non-normal distributional numerical variables data.The main results:1) Developed chronic disease prevention and control policy.2) Setup chronic disease prevention and control institutions and established a chronic disease prevention and control team.3) Proceeded social advocacy and behavioral intervention.4) conducted the chronic disease monitoring and management aimed at the hypertensive patients.5) Hypertension prevalence in the intervention group rural residents was2.48%lower than the baseline group,6.72%lower than the control group.6) The smoking rate in the intervention group hypertensive patients was1.25%lower than the baseline group,0.04%lower than the control group but had no significant difference; The intervention group quit rate was3.12%higher than the control group, but had no significant difference; the overweight rate of intervention group hypertensive patients was0.16%lower than the baseline group;3.87%lower than the control group, had no statistical significance. The intervention group obesity rates was3.81%higher than the baseline group;1.16%lower than the control group, but had no significant difference.7) The blood pressure level of intervention group hypertensive patients was lower than the control group and the baseline group.8) The intervention group hypertensive patients’complication rate was lower than the control group and the baseline group, but had no statistical significance.9) Four weeks attendance rate and hospitalization rate in the intervention group hypertensive patients were higher than baseline and control groups but hospital days reduced.10)Four weeks treatment costs of the intervention group hypertensive patients reduced than the baseline group and the control group, hospitalization costs increased and the blood pressure costs flat essentially in the past year, but the proportion of the fees accounted for increased annual income was lower than the baseline group, higher than that in the control group.Conclusion:1) Patients covered by free medicine policy were more likely to take medicine regularly and the free medicine policy was useful to solve the problem of low-compliance caused by payment difficulty.2) Free medicine policy can help reduce the economic burden of poor patients with hypertension.3) The free medicine policy was not effective for the control of blood pressure and there were some problems in the implementation of the program.4) Most patients covered by the program were satisfied with it.Policy recommendations:1) To further strengthen chronic disease prevention and control agencies, teams, policy construction, and play fully the role between chronic disease prevention and control departments and policy.2) To emphasis on the prevention of chronic diseases, strengthen the monitoring of chronic diseases and standardize the management of chronic diseases. Further strengthen the propaganda of knowledge about chronic disease prevention; enhancing the patient’s education and transforming the patient’s concept to promote actively behavioral changes.Build sport venues; consolidate chronic disease monitoring and intensify the monitoring capability and level, establish the systematic collection method of sustainable chronic disease and their risk factor data; improve the chronic disease management network construction.3) To instruct the hypertensive patients to use reasonably the health service. Make full use of chronic disease surveillance information, and include hypertensive patients to the chronic disease management timely; standardize the management of chronic disease, to ensure the frequency and quality of follow-up and improve the management quality and efficiency; improve continuously the level of village medical clinics, give a reasonable treatment plan according to the patient’s condition and instruct the hypertensive patients to use reasonably the health service health services; Strengthen the compensation supervision of chronic disease, to ensure the hypertensive patients using health service adopted to their condition, that was not the health service needs were lacked, nor the abuse of health service; further strengthen public education, to guide the rural residents to participate actively in the health check, and advocate chronic patients to participate in chronic disease management, treatment actively, use reasonably health service to prevent aggravation of the disease, to ensure and improve life quality. |
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