| Objectives:To understand the management status of chronic disease health records in Kunming. To investigate the present situation of the chronic disease health records of four community health service centers in the urban zone. To study the quality of the chronic disease health records, and the cognition and using situation of chronic disease health records of the community health workers and patients. Finding out the problems and insufficiency that exist in the implementation process of chronic disease records. Discussing the factors that restrict the management of chronic disease health records. To provide references for implementing chronic disease health records effectively, improving the management efficiency of chronic diseases and the quality of community health service, easing the disease burden of individuals, familys and social.Methods:Selected four community health service centers randomly and respectively from four administrative districts of the urban zone of Kunming. Through personal interviews to understand the management situation of the chronic disease health records of Kunming municipal public health administrative department, as well as the information in chronic disease health records in four community health service centers. With the health records of hypertension and diabetes as example, selected 782 chronic disease health records in total. Designed questionnaire according to the national basic public health service specification requirements and investigated the records and utilization of the chronic disease health records. On a random sample of 40 medical personnel and 80 patients with chronic diseases, questionnaire survey was used to understand the personal basic information, the cognition and use of chronic disease health records. Epidata3.1 was adopted to establish the database after data verification, double entry, parallel import SPSS 17.0 software for statistical analysis, according to the objective of the data category, distribution characteristics, and analysis of data, using statistical methods include descriptive statistics analysis, χ2 test and the multi-factor logistic regression analysis, etc., with P< 0.05 for the difference was statistically significant.Results:1.Kunming chronic disease health records work management status:Kunming municipal public health administrative department have payed attention to chronic disease health records work.In the aspect of system, mainly relying on the national policy to develop chronic disease health records work, and regularly conducted supervision and examination. In the aspect of human resource configuration, chronic disease health records administrators was required, but did not make specific requirements for the number. There wsa no special funds for chronic disease health records work,it was packaged in basic public health services funds. According to the jurisdiction of population,40 yuan per person per year.2.The implementation of chronic disease health records in community health service centers:In terms of system, four community health service centers were set up relevant management system and performance appraisal system, but 82.5% of the medical personnel reflected that chronic disease health records work was not included in individual performance appraisal system.In terms of human resources, each community had a 1-2 administrator, only one community administrator was full-time, the rest were part-time. In terms of the utilization of records, mainly through physical examination, health education activities and follow-up, bringing patients with the chronic disease health records into standardized management. Part of the communities organized regular chronic disease self-management group activities. In terms of informatization, four community health service centers did not have a unified information system, electronic health records only in the stage of information storage for now, not achieving inter connectivity and regional health information sharing.3.Chronic disease health records quality and utilization status:in terms of complete integrity with 782 chronic disease health records, individual basic information part was completed well. Health physical examination and follow-up records had varying degrees of lack of leakage. The highest short rate is auxiliary examination and referral items, respectively with 38.6% and 62.9%. In the other medical and health service record integrity, health education activities and consultation items had no records, lack of items at a rate of 100.0%, referral and accepts items lack rate were 98.6% and 86.7% respectively.53.5% records had medical record in the latest years.92.3% of the records had have follow-up record in the latest years. There were no records in "referral" "consultation" and "health education activities" parts.4. The cognitive and using situation of chronic health records of the community medical staff:40 medical personnel thought that it was necessary to develop chronic health disease records work in community health service centers.77.5% of them have built records for patients.82.5% of the medical staff can update treatment and follow-up information with records timely. The utilization frequency of 47.5% medical staff was high,52.5% was low. logistic regression analysis showed that "if chronic disease health records work was included in the performance appraisal" entered the regression equation, Wald test P value= 0.033< 0.05, the difference was statistically significant. Medical staff use of archives for chronic health have focused on physical examination, follow-up and health education aspects, accounting for 82.5% and 77.5% and 82.5% respectively.5.The cognition of chronic health records in patients:In 80 patients, the chronic health records witting rate was 48.7%.38.8% patients confirm the function of chronic disease health records.75% patients were willing to create records. The witting and willingness rate of the urban employees’medical insurance patients were higher than urban residents medical insurance, new rural cooperative medical insurance and uninsured patients, statistical analysis results were χ2= 9.959, P=0.019<0.05,χ2= 8.024, P=0.05<0.05, the difference is statistically significant. Male patients willingness rate was higher than women (x2= 4.057, P=0.042<0.05); widowed patients willingness rate 1 higher than other patients with marital status (χ2=6.163, P=0.046< 0.05); the patients who confirm the function of chronic disease health records had a higher willingness rate than who don’t (χ2= 6.338, P=0.012<0.05), the difference was statistically significant.Conclusions:1.The public health administrative department valued chronic disease health records work. Have provided basic conditions for the community to carry out the chronic disease health records work, but the strength of the funds safeguard, personnel raising and informatization construction had to be strengthened.2.Community health service centers actively implemented chronic disease health records work, but due to the imperfect management system, incentive mechanism and inadequate human input, community health records work existed some problems. Such as pursuiting the create rate but ignoring the quality and utilizatio. And the management status remained to be further improved.3.The recognition of the community health workers to chronic health records work is high, but as a result of workloads, understaffed, lack of efficient and practical information system support, as well as the imperfect performance appraisal mechanism, community health workers enthusiasm was not high, using frequency was low.4.Due to the lack of early propaganda, low informatization level, as well as the worries about privacy, patients lack of awareness and understanding of the chronic health records,and lack of contact with their own health records. The awareness rate, recognition and willingness of chronic health archives of patiens intended on the low side. |
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