| Objective To explore the status of community-based management for hypertension and diabetes in National Primary Public Health Services in some areas of Shandong and Jiangsu Provices.Methods In this cross-sectinal study,we used multi-stage stratified random sampling method to collect participants aged 35 years and older.Those participants were selected from 2 districts and 4 counties in Jiangsu and Shandong Provinces from December through November in 2014.By cluster random sampling,4 community health service institutions(CHSIs)in each district and 3 CHSIs in each county were selected.Among 20 CHSIs,9 CHSIs of them were selected to participate in the investigation for CHSIs,Patients with a diagnosis of hypertension or diabetes for 3 months or over were randomly selected in 20 CHSI’s health file records.A well-structured questionnaire and physical examination were applied to obtain information,such as demographic characteristics,utilization and provision of health services,lifestyle intervention,medication,and anthropometry parameters.Management rates and standard management rates were defined according to National Primary Public Health Services Specifications.Rates of drug uses including regular use,drug combinaton and statins or aspirin use in high-cardiovascular-risk population were defined according to related guidelines.A Chi-square test was applied to compare the proportions in different characteristic groups and a non-conditional logistic regression was used to analyze the factors affecting controls of blood pressure and glucose.Results1.Management 9 CHSIs managed 40 094 hypertensive patients,with a management rate of 46.1%(95%CI:45.8%～46.5%),and 8 268 diabetic patients,with a management rate of 36.6%(95%CI:36.0%～37.2%).A total of 1 511 qualified hypertensive patients and 1 508 qualified diabetic patients were surveyed,of which 751 in urban and 760 in rural for hypertension,748 in urban and 760 in rural for diabetes.48.5%(95%CI:46.0%～51.1%)of patients with hypertension and 28.5%(95%Cl:26.1%～30.7%)of patients with diabetes received standardized management.18.7%and 35.3%of diabetic patients did not received recommendations on retinal and foot examination over the past year.2.Treatment The rates of administration,regular medication and combined medication in hypertensive patients were 71.3%(95%CI:68.9%～73.6%),42.3%(95%CI:39.8%～44.8%),and 30.1%(95%CI:27.8%～32.4%),respectively.The rates of administration,regular medication in diabetic patients were 77.5%(95%CI:75.4%～79.6%)and 71.6%(95%Cl:69.2%～73.8%),respectively.Statin and aspirin use rates were 9.1%(95%CI:7.6%～10.6%)and 19.3%(95%CI:17.0%～21.1%),respectively,in high-cardiovascular-risk diabetic patients.3.Control The control rate of blood pressure in hypertensive patients was 38.4%(95%CI:35.9%～40.9%).The control rate of blood glucose in diabetic patients was 40.8%(95%CI:38.3%～43.4%).Both the two control rates were significantly higher than the findings from national representative surveys(P<0.01).Multiple logistic regression analysis showed that high school degree and above(OR = 0.52,95%CI:0.39-0.70),per capita annual income>20 000 yuan(OR = 0.73,95%CI:0.55～0.95),regular medication(OR = 0.69,95%CI:0.54～0.87),weight control(OR = 0.67,95%CI:0.54～0.85)and glycemic control(0.56,95%CI:0.40～0.78)were the advantageous factors for blood pressure control,disease course>10 years(OR = 1.77,95%CI:1.38～2.28)was the disadvantageous factors for blood pressure control.Living in city(OR =0.71,95%CI:0.55-0.91),per capita annual income>20 000 yuan(OR = 0.65,95%CI:0.49～0.85),weight control(OR = 0.69,95%CI:0.55～0.87)and standardized management(OR = 0.76,95%CI:0.61～0.95)were the advantageous factors for glycemic control,however,aged<55 years(OR = 2.12,95%CI:1.52～2.94),disease course>10 years(OR=1.97,95%CI:1.50～2.59)were the disadvantageous factors for glycemic control.Conclusion Selected CHSIs had moderate high management rates of hypertensive and diabetic patients.Standardized management rate in diabetic patients need to be improved.Community physicians’ skills need to be improved in clinical drug treatment and complication prevention.Community-based management for hypertension and diabetes have yielded initial results.Further improve the control level of hypertension and diabetes,need to pay attention to patients with long disease course,low income or overweight status. |
PDF Full Text Request