| ObjectiveBy investigating the concrete implementing situation of the basic public health service in Gansu province, the main problems of the residents’ health management service were found in grass-roots public health agencies, and knowing the degree of satisfaction about residents and grassroots public health service personnel to implementation of the service. Based on the investigation and analysis of these problems, some effective suggestions were put forward to improve health management quality of residents in basic public health services agencies, boost the degree of residents’ knowledge about all kinds of health services and enhance the satisfaction of residents and health officers.MethodThe typical sampling method: Choosing Kangle county of LinXia state, Huining county of Baiyin city, Liangzhou district of Wuwei city, Chengguan district of Lanzhou city, Xiahe county of Gannan state, Qingcheng county of Qingyang city, Cheng county of Longnan city in Gansu province as the sample counties; using the simple and random sampling method investigates, which extracts 2-4 health clinics in towns and townships/community health service centers.The questionnaire method: By distributing the questionnaires randomly to basic public healthy staff, urban and rural residents around basic public health service agency, to survey that degree of residents’ knowledge about the service projects, degree of satisfaction about residents and grassroots public health service personnel to implementation of the services. At the same time, some health records of the hyperkinetic, diabetes, the elderly residents and pregnant and lying-in women were extracted randomly at the grass-roots units that had been chosen as samples. To measure the patient’s blood pressure, blood sugar, to ask times of follow-up visits for them by family interviews; to ask the situation of health examination for the elderly, record the times of follow-up visits for pregnant and lying-in women by telephone interview. By means of literature analysis method, to consult the relevant policies and files, supplement necessary data, and check authenticity of data; to collect and sort the periodicals and research data, learn about the related research status, methods and results.The questionnaires were input the data with adopting the double-blind method by use of EpiData3.0, these input datum were sorted and analyzed by using SPSS 20.0 and Excel 2010, the obtained results were processed with quantitative and qualitative statistical description. Quantitative data were shown using the median statistics, statistical tests were mainly conducted with nonparametric test of Wilcoxon and Kruskal Wallis test; categorical datum were described with the constituent ratio index, the datum was tested making use of chi-square test.Result1. Among 286 hyperkinetic-patients of the last family follow-up in 2014, the records were shown that the median of systolic blood pressure was 134 mmHg, the rate of abnormal systolic blood pressure was 29.39%, and the rate of abnormal blood pressure was 36.01%. The average times they were visited were 3.74 times per patient, the rate of joining in health examination was 74.48%.The results about inventory survey in 2015 were that the median of the systolic blood pressure measured at home was 147 mmHg, the rate of abnormal systolic blood pressure was 67.83%, and the rate of abnormal blood pressure measured at home was 71.68%. The actual average times of asking for patients were 3.63 times per patient, the actual health examination rate was 76.57%. 71.23% of them knew that they were established health archives. By chi-square test, the difference of blood pressure between the records and actual datum had statistical significance.2. Among 228 diabetic patients of the last family follow-up in 2014, the records were shown that the rate of abnormal blood sugar was 46.19%, the average times they were visited was 3.53 times per patient. The results about inventory survey in 2015 were shown that the rate of abnormal blood sugar was 50.85%, which was measured at patients’ home, the average times of asking for patient was 1.01 times. 99.56% of them knew that they were established health archives. By the nonparametric test of Wilcoxon, the difference of follow-up visit time between the records and actual datum had no statistical significance.3. Among 272 pregnant and lying-in women of the last family follow-up in 2014, the records were shown that the recording times of antepartum family follow-up visit was 4.96 times per person, the recording times of postpartum family follow-up visit was 2.02 times per person. The results about inventory survey in 2015 were shown that the actual value of antepartum family follow-up visit is 3.89 times per person, the actual value of postpartum family follow-up visit was 1.83 times per person.77.90% of them knew that they were established health archives. By the nonparametric test of Wilcoxon, the difference of antepartum and postpartum follow-up visit time between the records and actual datum had statistical significance.4. Among 268 old people, the recording rate of joining in the health examination was 71.64% in 2014. The results about inventory survey in 2015 were shown that the actual health examination rate of asking for them was 79.48%, 66.79% of them knew that they were established health archives. By chi-square test, the difference of rate about joining in health examination between the records and actual datum had no statistical significance.5. The average degree of residents’ knowledge about basic public health services was 47.24%, the degree of male residents’ knowledge was higher than female. The degree of residents’ knowledge was decreased along with the increase of age group. The degree of the urban residents’ knowledge was higher than rural residents. The degree of residents’ knowledge was lower than others with good cultural level. The degree of residents’ knowledge was lower than others working in the public institution. The degree of residents’ knowledge was low in Chengguan district(42.06%). The degree of residents’ knowledge was the highest to the health service of the elderly(73.06%), the degree of residents’ knowledge was the lowest to the health service of the psychopath(49.82%). Most residents knew about the basic public health services mainly through television and radio, then public health staff in community.6. Through carrying out the health education service, the residents knew more about the risk factors of chronic disease, but they were unaware of the propagative way about infectious diseases.7. In basic public health services, residents were most satisfied with the "convenience"(the proportion of residents’ number on satisfaction was 67.71%) and "staff service attitude"(the proportion was 69.74%), "drug prices"(50.74%) and "patient privacy protection"(48.71%) was the lowest in degree of residents’ satisfaction. The degree of residents’ satisfaction about “equipment” and “diagnosis and treat result” was the lowest(the proportion was respectively 6.83% and 4.43%)8. The degree of satisfaction about Grassroots public health officers was 87.31% for the holistic work, the highest assessment was marked to the management level of the work by staff(90.17), but the assessment of training opportunity for staff was the lowest(84.42). The degree of health officers’ satisfaction in Chengguan district was the highest, which was marked 92.32.In basic public health service personnel who were surveyed, 79.60% of them thought that their job’s satisfaction had been improved; 66.53% of them thought that their development opportunities would better; 89.11% of them believed that the work had been improved the doctor-patient contradiction; 71.89% of them thought that their workload was increased than before, but they were able to sustain; 68.40% of them believed that their income had not changed; 36.00% of them didn’t know the issue mode of subsidies.The public health staffs were guided and trained by holding meetings mainly(the proportion of health officers’ number was 89.67%), the proportion of health officers’ number of joining in technical guidance provided by superior doctors was 31.40%.Conclusion1. In the seven counties of Gansu province, the controlling effects of blood pressure and the hypertensive and blood sugar of diabetics were poor. Follow-up visit work of Health management was scanty. The follow-up visit times involved in patients with the hypertensive, diabetes and the maternal failed to reach the national requirements. The condition for health examination of the elderly and the hypertensive was good, the situation of health examination for residents was better.2. The content of residents’ health records existed lots of information blank, wrong information, even fictitious and useless record. The value of blood pressure, the average time of follow-up visit of hyperpietic-patients, diabetic-patients and pregnant and lying-in women were untrue.3. Residents didn’t know about the basic public health services too much because of single and inadequate publicity means, but they are satisfied with it. So the overall health environment configuration and medical level still needed to be promoted, the service quality of the medical staff also needed to be improved.4. Grassroots public health workers were satisfied with their whole job, at the same time, they demanded for the more technical training. There are lack of professional public health staff in grass-roots health institutions, many health staffs were not equipped with the professional technology and professional quality, lack of necessary medical testing equipment and hardware facilities. |
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