| Objective: To investigate the current situation and demand of health management service from both the supplier and the demander through quantitative study and qualitative study,which provides evidences for the intervention strategies to control chronic diseases.Methods: Stratified random sampling was applied to select 8 primary health care institutions in Hong Huagang district of Zunyi in Guizhou province.Questionnaire was used to investigate the basic information,dietary habits,lifestyles,disease status of health management,their awareness,utilization and assessment of health management services of the patients with chronic diseases in Zunyi.Through purpose sampling method,we used In-depth individual interview with staff responsible for NCDs management,NCDs health management leader of the centers for disease control and prevention,NCDs health management provider and director of community health service centers in the 8community health service facilities,so as to investigate the service mode,service effectiveness,software and hardware conditions,service cost,existing problems and influencing factors of health management of the NCDs.The survey data were established into a database using Epidata3.1 and analyzed using SPSS17.0,and lifestyles of NCDs patients and their utilization and assessment of health management services were screened out through chi-square test and dichotomy logistic regression analysis.We processed and analyzed the qualitative materials collected in the study through thematic framework method which is widely adopted internationally.Results: 1.The survey of Zunyi NCDs health management of primary health institutions found that:(1)In terms of health service providers,a majority of participants were female,and their specialties were nursing,and professional title were primary.A majority of the investigated primary health facilities all have provided NCDs health management services in accordance with the 2015 Edition National Basic Public Health Service Specifications.The survey of in-depth interview found utilization of follow-up and physical check-up were best,and classification intervention were the worst.The NCDs population had a high satisfaction rate of the items of health management services.Improving chronic disease health management strategy of primary health institutions included puting leaflets in the district,increasing inspection items,providing residents free drugs.Problems of NCDs health management included the cause of the chronic disease health management items,shortage of manpower,insufficient equipment,simplex and shortage of drug,shortage of the national financial funds,inharmonious multi-agencies cooperation,insufficient assessment.(2)The questionnaire results show that awareness,utilization,satisfaction of basic public health service among the resident were relative better in general.Age,residence,professional was potential association with awareness of hypertensive screening,and the awareness of hypertensive screening items of city resident was higher than that of rural(P<0.05),and age was potential association with awareness of hypertensive physical check-up,and awareness of hypertensive physical check-up of 50-60 years old residents of hypertensive physical check-up was higher than that of less than 50 years old residents(P<0.05).Age was potential association with utilization of hypertensive physical check-up,utilization of hypertensive physical check-up of 50-60 years old residents was higher than that of less than 50 years old residents(P<0.05).Age,community,resident,occupation was potential association with awareness of diabetic screening,the awareness of diabetic screening of less than 50 years old residents was higher than that of 50-60 and 60-70 years old residents(P<0.05),the awareness of diabetic screening items of city resident was higher than that of rural resident(P<0.05).Age,resident,marital status was potential association with utilization of diabetic screening,and the utilization of diabetic screening items of 50-60 years old residents of was higher than that of less than 50 and 60-70 years old residents(P<0.05).2.ssessment of primary health institutions carrying out NCDs health management in Zunyi city indicated that:(1)NCDs burden was heavy in Zunyi,and respondents suffered10 kinds of chronic diseases.Prevalence of hypertension was 54.6%,followed by diabetes(20.1%),dyslipidemia(13.4%),coronary heart disease(11.7%),and chronic bronchitis(8.4%).57.6% respondents suffered two or more chronic disease.In the whole,lifestyle need improvement,but 36.1% people were still lack of physical activities,16.1%,7.9% and 18.3% people have habits of smoking,alcohol drinking,and sleep time of less than 5 hours respectively.Most residents had good diet habits,but 8.9% residents didn't take breakfast every day,and 9.5% residents eated too much in dinner,and 40.5%residents eated vegetables less than 300 grams,and 16.1% took too much salt.(2)In-depth interviews indicated that the expect high blood pressure and diabetes,coronary heart disease,cerebral infarction,myocardial infarction,hyperlipidemia should be managed.It also indicated lifestyle and diet intervention effect of NCDs patient was not ideal.Priority health problems were increasing physical check-up item,implementing of follow-up and classified intervention in criterion,improving health provider's professional ability.In terms of health resources available for health management of the NCDs,health service providers hoped that the primary health institutions and medical insurance,social insurance should joined up,and the dual referral should really implement,and local governments,subdistrict office and residents' committee should take part in the publicity activities.Conclusions: 1.The ability of primary health institutions to carry out the NCDs health management was insufficient,and a primary health institutions was not fully in accordance with the basic public health service standard.2.State propaganda of NCDs health management failed to meet the requirements,and the awareness of NCDs health management of resident was insufficient.3.NCDs burden was heavy in the area,so except the diabetes and hypertension,dyslipidemia and coronary heart disease(CHD)should be also bring into the NCDs management in primary public health care items.4.Health Intervention and guidance on exercise,sleeping,smoking,drinking,and eating habits should be emphasized.5.Carrying out the NCDs health management of primary health institutions is also facing with the following challenges including unreasonable requirements of the items,,lack of residents' health consciousness,lack of health resources,insufficient of national investment,inharmony of multi-angencies' cooperation. |
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