Study On The Situation And Affecting Factors Of Chronic Disease Community Management In Hengyang

Objective:Throughcollecting 7 basic medical and health service institutio ns(5 community health service centers and 2 township hospitals) for chro nic disease management Hengyang Yanfeng District, relevant data has been analyzed, and then investigation and analysis has also been conducted from the angle of community patients with hypertension complicatedwith diabetes mellitusand thosenot suffering fromhypertensio n and diabetes mellitus residents as wellas community general practitione rs team responsibilitytocomprehensivelyevaluateindividual health educati on comprehensive prevention effect to the patients in community hyperte nsion complicated with diabetes mellitus.Factorsaffecting community chr onic disease management status and implement are probed so that the problems can be found out and suggestions for improvement can beputforward in order to promote the further development and provide a t heoretical basis in basic medical and health service institutions。Methods:This research mainly uses the literature research, field survey a nd in-depth interviews and other research methods. Firstly, the research method of literatureisusedtocomprehensively evaluate Hengyang basic medical and health service institutions for chronic disease management st atus and characteristics. Secondly, the survey research methodisconducte d, adopting the method of random sampling from 5 districts of Hengyang City, 1 randomly selected district(including 5 community health service c enters and 2 township hospitals). The first step is to randomly select860 cases of patients with hypertension and diabetes mellitus from ”the c ommunity health management information system"runbythe chronic disea se management 7 basic medical and health service institutions in Hunan P rovince.Next, all 50 and not suffering from hypertension and diabetes mel litus residents 350 areinvestigatedin the 7 community health service center survey of hypertension and diabetes patients. Then, the descriptive analy sisismadeinterms of community chronic disease management, community health services utilization of KAP,thecredibility and satisfaction; ANOV Astatisticsisconductedtoprobeintothe main factors affecting chronic disea se management work of community party inspection card. Finally, the GP team responsibilities related management staff for the individual are coll ectively interviewed。Results: The results reveals that the rate of patient files is 99.8%, and health Management rate of hypertension and diabetes is 55.89%、52.12%, and standardized management rate46.36%、43.65%。 1.860 patients with hypertension and diabetes were randomly selected as the research objects from the pioneer community in Hengyang city. By individualized health education, in terms of diet about community patients with hypertension and diabetes mellitus, the greatest change are high salt intake(52.32%) and drink(34.88%),but not smoking(62.56%). Compared to the controls and same period of before intervention, the intervention group related metabolic parameters such as bloodpressure[(130.89±8.70)(78.29±4.75)],fastingbloodglucose[(6.69±1.36)], 2-hour postprandial blood glucose [(8.81±1.24)], glycosylated hemoglobin [(6.38±1.03)]and triglyceride [(1.23±0.68)], blood lipid have decreased. The difference was statistically significant(P<0.05). Compliance: after 24 months treatment, the compliance of intervention gr oup was significantly higher than control group. The difference was statistically significant(P<0.05). Two groups of patients in the awareness rate(from 61% to 91%)the cure rate( from 60% to 88%), the control rate(fro m 68% to 90%), curative effect satisfaction( from 95% to 71%) and othe r aspects of comparison: the analysis results showed that 24 months after t he intervention, the intervention group was significantly higher than that i n the control group with significant difference(P<0.05). Frequency of two groups of patients takingadvantageofcommunity health service center and monitoring of blood pressure, blood sugar was statistically significan t, P<0.05 = 38.13。 2.Investigationof350 residents’ cognitionwithout hypertension and diabetes mellitus: the residents of the measurement of blood pressure, glu cose / health education lecture / consulting, the establishment of health re cords, health examination, other content awarenesswere respectively 58.57%, 35.71%, 52.57%, 34.29%, 22.86%; requirements: the highest propor tionfor the physical examination and on-site service demand were 68.57%, 58.57%amongtheresidents; Affecting factors: 112 of the residents are no t willing to accept the community management and service with the following reasons---lack of time; having little information, having little effect, poor service, low proficiency, and others; the proportion accounted for 11.43%, 10.86%, 1.43%, 1.71%, 3.43%, 3.14%。 3. The investigation of 700 cases of hypertension and diabetes mana gementincludedgeneral outpatient service, follow-upphonecall, follow-up visit, noneed.Patients with hypertension were 55.71%, 44.29%, 32.29%, 7.71%, 52.59%, 41.14% respectively in patients with diabetes mellitus, 29.71%, and6.57%.inthemidstof management,those willing to accept the blo od pressureandblood sugar of patients accounted for 84.29%, 81.71%resp ectively, followed by physical examination and follow-up. Hypertension r isk factors in the common management effect(heredity, obesity, excessive drinking and smoking) awareness rate was more than 60%; however, pa tients with diabetes than in hypertensive patients with lower rate of diseas e; at the same time, the blood pressure and blood sugar level of understan ding of normal value is greater than 50%. In the medication compliance i n patients with hypertension, treatment rate and control rate of medication accounted for 86.29%, 65.43%; patients with diabetes medication rate an d control rate of medication accounted for 85.43%, accounting for 30.86%. The health education and behavior change show the results in the rece nt 2 years that hypertension, diabetes management in the way of life has c hanged, especiallythe change of maximum dietary. In patients with hypert ension, diabetes accounted for 80.58%, 91.34%; but the effect of behavioral interventioninquitting or reducing smoking, drinking, exercise, weight control, mental state should be further improved. The contents of this satisfaction survey include6 contents of project management, servi ce attitude, medical environment, technical level, management efficiency, service prices.Theoverall satisfaction was greater than 60%. The content of management, service attitude, medical environment aregenerally more than 80%, which are respectively is 81.29%, 82.29%, 81.29%. However, the level of technology, management, service price is lower than the avera ge, respectively 61.29%, 63.29%, 62.14% 4.Investigation of 149 cases of management personnel shows most of them mainly major in health care with 72.48% having received college education accounted, 67.11%havingthe monthly income of 2000 orso, 57.72% beingthe registeredstaff,and the workload and work satisfac tion accounting for 12.08%, 9.34%.Conclusions: Chronic disease management in community has been formed and achieved some success in Hengyang City. However, there are such disadvantages as the overall low level of management, bad management effect and low satisfaction from the residents. At the same time, the general community responsibility and the individualized health education intervention by the medical team have better effect in community patients with hypertension complicated with diabetes mellitus. The patients maintain a stable status. In general, the desire of patients and public health policy of community health services, operation and management level of the basic medical and health service institutions, willingness of the patients and residents, the degree of satisfaction, cognition, and income level of the related staff engaged in chronic disease management and stability are all the affecting factors of community management of chronic diseases.