| Background and ObjectiveAt present,the prevention and control of chronic diseases in domestic is grim.According to The Nutrition and Chronic Disease Status Report of Chinese Residents(2015),in 2012 the chronic diseases mortality of national residents reached up to 533/100,000,accounted for 86.6%of all deaths.The disease burden of chronic diseases accounted for more than 70%of the total burden of disease.Chronic diseases pose a great threat to the safety of people's life and property.What's more,chronic diseases often last for a long time,so it would cause a heavy burden to the society and patient's family.Bad lifestyles,such as unhealthy eating,drinking,smoking,sedentary and so on,are the roots of many chronic diseases.Chronic diseases can be prevented and controlled through standardization management.But people pay very little attention to chronic diseases.A variety of chronic diseases' management needs to be improved,for example,the management of chronic atrophic gastritis.As early as 1978,the chronic atrophic gastritis had been defined as precancerous lesion of gastric carcinoma by World Health Organization.Both morbidity and mortality of gastric carcinoma are in the front rank in all tumors,which causes great pain and burden to society and patient's family.However,there is little research on the management of chronic atrophic gastritis in domestic.General practitioners are the main undertaker of chronic diseases' management.In order to understand the management status of community chronic diseases,especially the management of chronic atrophic gastritis,we designed two kinds of questionnaires.One is for general practitioners and the other is for the residents in community.In addition,we interviewed the general practitioners.After analyzing the result of the questionnaires and interviews,we put forward some relevant suggestions on the concept of general practice,in order to provide reference for general practitioners to carry out chronic atrophic gastritis management.MethodsThis paper mainly uses the literature data method,questionnaire survey method,interviewing method to investigate and research the management status of chronic diseases and chronic atrophic gastritis in community.We searched the literature about the management of chronic disease and chronic atrophic gastritis and designed questionnaire from October to November 2016.The questionnaire divided into two parts,residents and physicians version.We handed out questionnaires and interviewed all of the general practitioners who have done the questionnaires in jinan Beicun and Yanshan community and community health service centers from December 2016 to February.2017.All respondents are voluntary.650 residents had received this questionnaire and 637 answered questionnaires were availabl,The recovery rate is 98.0%.26 general practitioners had received this questionnaire and 26 answered questionnaires were available.The recovery rate is 100%.Take the questionnaire as the outline,we interviewed all those 26 physicians.After interviewing,we sorted and summarized.This paper uses Epidata3.1 software to establish the database,and adopts double machine duplicate entry to repeat import in order to ensure the accuracy of the data.This paper uses SPSS19.00,a kind of Statistical Analysis Software,to collect and analyze the data.During the process,it adopts many statistical approaches such as Descriptive Statistics,Chi-Square Analysis and Binary Logistic Regression Analysis to collect and analyze the data.Results1.Community residents' awareness of chronic diseases and it's relevant knowledge.43.3%of community residents do not know or know little about chronic diseases and 86.7%of community residents do not know or know little relevant knowledge about the management of chronic diseases.Residents have more knowledge about diabetes and hypertension,but have less knowledge about other chronic diseases.Community residents mainly obtain relevant knowledge of chronic diseases through network and social media rather than from health service center.People over age 50,who are suffering from chronic disease know more about chronic diseases and the management of it.2.Community residents' awareness of chronic atrophic gastritis and its relevant knowledge.84.9%of community residents know little about chronic atrophic gastritis or even never heard of it.let alone the relevant knowledge of chronic atrophic gastritis.But residents have a higher awareness of the relationship between chronic atrophic gastritis and gastric cancer.85.6%of residents have never done gastroscope,Residents know less about chronic gastritis than chronic diseases.3.Residents' recognition of community health service centers and the choice of first visit hospitals39.5%of the residents accept the medical services that provided by the community health service center:46.3%of residents think the medical services that provide by the community health service center are general.Only 25%of the residents choose community health service center as the first visit hospitals,and 59.6%of the residents choose to go to the general hospital.The remaining 15.4%choose not to see a doctor.From this we can know that community health service centers have a low recognition and credibility for residents.4.Current status of community general practitioners in chronic disease management.The main chronic diseases managed by community general practitioners are diabetes and hypertension,and the management of other chronic diseases is less.The main job of general practitioners is to prescribe medicine in the management of chronic diseases.Health education,health records,follow-up visit are carried out,but the intensity is not enough.57.6%of general practitioners believe the effect of chronic disease management is not good or general,the main reason is the heavy workload,difficult to implement the refine and individualized management,less a venereal chronic disease standard management.There are 7.7%and 34.6%of the community general practitioners think chronic disease management effect is very good and good.The main reason is the key management of chronic diseases has made good results.Community general doctors think the cause of slow disease management difficulty is in turn:the lack of corresponding policies,society does not value,the lack of incentive mechanism,big workload,patients do not recognize.The government's policy support,improve the relevant treatment,improve the social recognition will improve the enthusiasm of community general practitioner.5.Community general practitioner's suggestion on standardized management of chronic atrophic gastritisAt present,the reasons why the community do not carry out standardized management of chronic atrophic gastritis are that chronic atrophic gastritis is not the key regulatory chronic diseases;the communities lack common equipment used in the treatment of chronic atrophic gastritis;referral system is not perfect;and the knowledge and skills of general practitioners in chronic atrophic gastritis management need to be improved.Therefore,we should strive from the following aspects to carry out the standardized management of chronic atrophic gastritis:policy support,community hardware construction,referral system consummation and physician training.Conclusion1.Now the management of diabetes and high blood pressure is carried out relatively well in the whole chronic diseases management in Ji'nan city.But the management of other chronic diseases is general.Community residents,especially young people and people who don't have chronic diseases,don't pay enough attention to chronic diseases and its relevant knowledge.Therefore,residents know less knowledge about chronic atrophic gastritis.2.The main reasons why the communities of Ji'nan city do not carry out standardized management of chronic atrophic gastritis are that the number of community general practitioners is less which means the workload is very big;communities lack common equipment;the referral system is not so good;and the general practitioners are not familiar with the knowledge of chronic atrophic gastritis management.3.To effectively carry out the standardized management of chronic atrophic gastritis.we need to make joint efforts in the following aspects:(1)Relevant departments should give policy guidance and support:put chronic atrophic gastritis into the management of chronic diseases and health insurance areas in order to lead patients to go to community health service centers when they feel bad.(2)The construction of community hardware should be improved:community should better introduce the digestive system commonly used medical equipment and add the types of the commonly used drugs.What's more,it should pay more attention to prevention and healthcare and health education.(3)The chronic diseases' management of general practitioner needs to be improved:Organizing community general practitioners to learn the knowledge of chronic atrophic gastritis prevention and treatment so as to improve the level of general treatment concept and the lever of chronic diseases' management.4.Through standardized management of chronic atrophic gastritis,we can reduce the incidence of gastric cancer and improve the detection rate of early gastric cancer from the following aspects:prevent occurrence of chronic atrophic gastritis,active treatment of patients with chronic atrophic gastritis,regular endoscopic and pathological follow-up. |
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