Evaluation Of Longitudinal Integration Intervention Of Rural Chronic Disease Services Based On Demand Side

Background:With the accelerated aging of the population in our country and the high incidence of chronic non-communicable diseases,the development of the health service system also requires a gradual shift towards “integration”,especially in rural areas.Practice has proved that the fragmented medical service system will not only cause waste of resources,but also cannot promote the improvement of the overall quality of medical services.Therefore,it calls for the elimination of fragmented and decentralized medical services.In the vertical integration of health service systems at all levels in rural areas,chronic disease services are one of the most appropriate and the most important project in service collaboration and integration.At present,chronic diseases have become a social problem and a public problem affecting the health conditions of our residents.The problem of chronic diseases in rural areas in China is even more severe.Therefore,focusing on chronic diseases,the promotion vertical integration among medical institutions and the provision of continuous medical and health services for the grassroots are important tasks for medical and health work in rural areas in China.Through the evaluation of the effect of longitudinal integration of rural chronic diseases on service interventions,exploring the effectiveness,problems,and solutions of the vertical integration of rural chronic diseases services will be conducive to the further advancement and improvement of pilot interventions to better guide and promote practice.Objective:This study aims to understand the effects of chronic diseaseintervention in rural areas through the study of the integration of rural chronic disease services at home and abroad based on theoretical research,and to clarify the specific effects of pilot interventions on chronic disease behavior lifestyle,awareness,medication compliance,and visit behaviors.disease control and medical expenses,clarifying the factors causing the effects,and proposing strategies suitable for the integration of chronic diseases in rural areas,and providing policy recommendations for the continuous improvement of the chronic integration of chronic disease services in rural areas and improving the health of patients.Methods: based on the DID model for the empirical research in Northern central and Southern of Jiangsu Province during 2015 and 2016,the sample is divided into control group and the intervention group,the comparison of the two groups of chronic patients in the vertical integration of health services implementation Pre-(2015)and post-implementation(2016)patient health behaviors and improvement of visit behavior.self-medication purchases and inpatient services were analyzed.Results:(1)The awareness rate of hypertension patients increased by 13.5%(P<0.05),and the awareness rate of diabetes patients increased by 8.6%(P<0.05).Overall,interventions have greater effects in patients with higher education levels,higher annual per capita income,and longer duration of illness,both of which are negative in older and non-marital status groups;(2)after intervention The dietary control of patients increased by 5.3%(P<0.05).The intervention had no significant improvement in smoking,drinking,and proper exercise habits(P>0.05);(3)After the intervention,there was no significant improvement in the referral rate of patients with chronic diseases.The percentage of patients with chronic diseases who selected primary medical institutions increased by 5.6%(P<0.05).Interventions were more effective in women,older,more highly educated,and closer to the nearest medicalfacility,but negative in long-term patients;hospitalization rates for chronic patients were reduced by 4.5%(P<0.05);(4)After intervention,the number of visits in the village clinics increased by 1.91(P<0.05).The effect of health self-evaluation is better and the duration of illness is longer,but there is a negative effect on the age,income level,education level,and distance from the nearest medical institution.In addition,the number of visits to hospitals in county and above hospitals increased,but there was no statistical significance(P>0.05);the number of visits to township hospitals and pharmacies declined(P<0.05).(5)After intervention,the blood pressure control rate of hypertensive patients Increased by 14.0%(P<0.05),and the glycemic control rate in patients with diabetes increased by 10.9%(P<0.05).(6).After the intervention,the total cost of treatment for chronic patients decreased by 366.25 yuan(P<0.05),and the out-of-pocket cost decreased by 362.88 yuan(P<0.05).The cost of patient visits in the village also increased by 115.14 yuan(P<0.05);(7)After the intervention,patients' satisfaction with follow-up service increased by 4.8%(P<0.05),and patients' satisfaction with health education lectures increased by 8.8%(P<0.05);the effect of intervention on cultural level was greater,but Negative effects are seen in people with high age and high per capita income.Suggestions:(1)Pay attention to personalized interventions to guide the development of healthy lifestyles for chronically ill patients;(2)Strengthen policy guidance and use integration services to promote the role of chronic patients in establishing a correct medical concept;(3)Perfection facilitates the integration of chronic diseases The basic medical insurance and drug policies for services can reduce the burden of disease on patients;(4)Improve interventions to ensure standardized services for chronic diseases.