Comparative Study On The Current Situation Of Community Management Of Patients With Hypertension And Diabetes In Kunming City And Hat Yai City

Objective:To analyze the current management situation of patients with hypertension and diabetes in Kunming city and Hatyai city, screening and comparing the factors that influence blood pressure and blood glucose control. To provide reference and basis for innovation chronic disease management model of Kunming, learning experiences of chronic diseases management from Hatyai city.Methods:Jinbi Qixiang Road community health service center and Natawee community hospital were selected as the field investigation sites. As they are the demonstration community of chronic disease management in primary health care service and the project cooperation point. Field investigation and interview were mainly used in this study. Purposive sampling was adopted to conduct questionnaire survey and a total of 277 patients were investigated, described and analyzed the management status according the survey results. Influence factors about the blood pressure and blood glucose control rates were explored by fitting binary logistic regression models. Community hospital administrators and health care workers were interviewed according to the interview outline and analyzed combine with the Policy information related chronic disease management.Results: 1. The blood pressure control rate of hypertension patients was 61.6% in Qixiang Road community. Binary logistic regression models showed the factors that affected blood pressure control is knowledge, age and whether treatment in community. Higher knowledge level, people younger than65 and patients who choose community health center have higher blood pressure control rate, differences were statistical significance. The blood glucose control rate of the diabetes was 42.9%. factors that affected blood glucose control including knowledge, management of risk factors, health insurance. Patients with higher knowledge level, better management of risk factors and medical insurance for urban workers have better glucose control level.2. The blood pressure control rate of hypertension patients was 83.6%in Natawee community hospital, and the blood glucose control rate of the diabetes patients was 54.8%.3. Qualitative interview results combined with collection of community data showed that the content of hypertension and diabetes management of Qixiang road community health service center content was carried out in accordance with national basic public health service specification. Doctors undertook the medical services and carried out the management of chronic diseases at the same time.4. Natawee Community Hospital implemented a series long-term viability of chronic disease management strategy, carried out health initiatives in detail:the formulating the hypertension, diabetes management plan; forming the multidisciplinary chronic disease management team; organizing hypertension and diabetes club; paying close attention to patients psychological problems; tailored "platform shoes" for diabetes patients; launched the patients'friends and relatives take care of them; using drugs for patients to quit smoking and so on.Conclusions:1. Hypertension and diabetes patients management model of Qixiang road community health service center is single,lack of personnel and funds, managers are not enthusiastic so the quality of service is decline. Natawee community hospitals implement delicacy management, diversity management model, management funds are guaranteed, doctors and patients with chronic decease have high enthusiasm to participate the management.2. Analysis of influencing factors on blood pressure control in patients with hypertension and diabetes show that knowledge awareness and risk factors management are greatly influenced the control rate. In the future, more attention should be paid to the publicity and education work about prevention and control of chronic disease. According to the situation of chronic disease management in Kunming City, the management should be individualized for the elderly, perfect the insurance system, improve community treatment ratio.3. Higher demand for community chronic disease management services in diabetes and hypertension patients. Community should improve the property and equipment standards of community chronic disease management, strengthen the health education, disease control guidance for patients.4.Kunming should reference the community management experience of chronic diseases from Hatyai city, improve service, perfect the management system, build a sound management model.Suggestion:1. Enhancing supervising functions of the government and the administrative department of health care, increase funding and staffing for chronic disease management.2. Strengthening the management of chronic disease in community health service institutions and innovating management mechanism.3. Improve the service level of community health service institutions, and strengthen the sense of responsibility.4. Enhancing the awareness of chronic disease prevention and treatment, the diagnosis and treatment of self-discipline of community residents and patients.