Queue-based Assessment Of Chronic Disease Patient Management Programs In Primary Health Care Institutions

ObjectivesBased on the two times of assessments of 8 provinces' primary health care institutions participated in the basic public health services of the management of chronic disease,to analysis the number of medical staff,basic working equipment,as well as the working conditions of the township health centers and community health service centers,so that we can learn more about their ability of managing the hypertension patients and the people with diabetes.Finally,we want to solve the problem found in the process and enhance the residents' health.Methods1.We analyzed the data correlated with the primary health care institutions'ability of managing the hypertension patients and the people with diabetes from the database of China CDC'program that names“the evaluation of the basic public health services in the management of patients with hypertension and diabetes project in 2015”,2.We compared the data of 2011 with the data of 2014.Results1.There was no difference between the number of the primary health care institutions' staff working on the associated program in 2011 and that in 2014.So it was same with the ratio of the primary health care institutions' staff working on the associated program.In 2014,the ratio of the primary health care institutions' staff working on the associated program in the east was 34.48%,which was lower than the ratio in 2011(71.11%,P=0.031).2.In 2014,the ratio of full time staff was lower than 50%,the permanent staff ratio approaching 50%and the ratio of the subsenior or above was about 3%,while the senior staff ratio was less than 1%.In 2014,the ratio of the permanent staff in the east(58.66%)was higher than that in the middle(29.03%)and the west(37.36%).The ratio of the subsenior or above in the community health service centers was higher(5.80%)than that in the township heath centers(1.01%,P=0.008,?=0.05).3.In 2014,of the several propaganda methods aimed to attract the residents,the method of distribution of related publicity materials was used by the most medical institutions(97.92%),on the contrary the rate of using the new kind of method including microblog and WeChat was the lowest(10.4%)and it was mainly used in the east.4.In 2014,the rates of equipping glycosylated hemoglobin test equipment and microalbuminuria test equipment in the township health centers and community health service centers were all relatively low(40%),but other rates of equipping the corresponding test equipment were all over 90%and their test rates were all above 73.75%.In 2014,the rate of equipping renal function examine instruments and the rate of examining the renal function were higher than corresponding rates in 2011(83.33%and 76.19%,respectively),of which the p values were all equal to 0,02.In 2014,the final costs of the patients' blood glucose test and renal function examination were all the highest in the middle region,than the other two regions.In 2014 the final costs of the routine urine test in in the community health service centers was higher than that in the township health centers(P=0.028),so did the final costs of blood glucose test(P=0.018).5.In 2014 97.92%of primary-level medical and health care institutions used the information systems to management the hypertension patients and the diabetes patients,and 80%of the information systems offer the several functions the questionnaire including,but the rates of the systems that could connect to other information systems were very low.The rate of transfer treatment by information system was higher in the east(91.67%)than that in the west(43.48%)and the p value was 0.01.The rate of the information system connective to the other information system of the township health centers was higher in 2014(70.83%)than that in the 2011(33.33%,P=0.01).Conclusions1.In general there was no big increase in the staff ratio associated with the program during 2011 to 2014.There was no difference between number of the total residents in the service coverage areas in the east and in the middle and west,since the prevalence of hypertension in the east was higher than that in the middle and the west,we conclude that the average workload of the staff in the east was the highest.2.Staff structure problems of the primary-level medical and health care institutions:full-time staff were less than the part-time staff and the permanent staff were less than the contacted staff,at the same time the number of staff occupying senior professional posts was very small.So it reflect a situation that the high technology staff was a lack,especially in the rural area.3.During the 3 years,the number of primary-level medical and health care institutions that could do the renal function tests increased and the number of township health centers in the west which could do the ECG(Electro Cardio Gram)test and the renal function tests also increased,especially in the west.4.In 2014,the number of institutions occupying the test equipment of glycosylated hemoglobin and microalbuminuria was small.5.The final costs for the blood glucose test,the blood lipid test and the renal function tests was higher in the middle region,the possible reason was that medical insurance reimbursement ratio were relatively low.The medical insurance reimbursement ratio of blood glucose test in 2014 were lower than that in 2011,which result to a higher final costs of blood glucose test in 2014 than that in 2011.6.Though there was a relatively high rate of equipping the information system,the information system had a low connection rate with the other information systems.7.In the nearly three years,the standard management rates of high blood pressure patients and the diabetes were greatly increased,of which,the rates in the west show the biggest increase.