| Objective:To investigate the awareness of chronic kidney disease of Kunming community residents.To investigate the chronic kidney disease health service providing situation of four community health service in urban zone.To analyze its influencing factors of awareness of chronic kidney disease in Kunming city.Than to sum up experiences and lessons,and puts forward some suggestions and improvement measures to improve the knowledge of chronic renal diseases in kunming community.Methods:Qualitative interview was uesd to find out the chronic kidney disease health service management of Kunming health administrative department and service conducting of four community health service centers in urban zone.Quantitative study including awareness of chronic kidney disease,cognition of chronic kidney disease and other influencing factors(Respectively is:PACT-AE scale and self-made questionnaire was used to investigate the community residents,getting their basic information,degree of chronic kidney disease risk,community health services utilization,community chronic kidney disease demand,self health assessment,etc.).Epidata3.1 was used for imputing data.Statistical analysis methods including statistical description,nonparametric tests and ordered logistic regression analysis were used.Results:1 Awareness of Chronic Kidney DiseaseThe awareness rate of chronic kidney disease in 996 subjects was 21.39 percent(95%CI 18.9%-23.9%),88.86 percent did not know the stages of uraemia,67.97percent and 68.21 percent did not know hypertension and cardiopathy are risk factors of chronic kidney disease.The awareness rates of basic knowledge about chronic kidney disease,therapeutic methods of chronic kidney disease and prevention methods of chronic kidney disease were 56.62 percent,33.43 percent and 45.48 percent.In addition,the definition and staging of chronic kidney disease,clinical manifestations of chronic kidney disease and the risks of chronic kidney disease are not optimistic,only 9.44 percent,29.52 percent and 23.90 percent.Just 7.93%of CKD's cognitive aspects of the disease were wrong that "sex with frequency or unhealthy sexual behavior leads to chronic kidney disease." "When asked if "sexual abnormalities should be in the kidney," 42.17 percent said "yes" and only 7.93%answered no 27.37 percent of the knowledge of chronic kidney disease was learned through television and 18.14 percent of the knowledge of chronic kidney disease through medical personnel.2 The current influencing factors of awareness of chronic kidney disease2.1 Management(Kunming health administrative department)(1)The current chronic kidney disease not included in the "The national basic public health service specification",health administrative departments and the community work of chronic kidney disease no policy basis and regulations,the whole community chronic disease management system for the management of chronic kidney disease not given enough attention.(2)Resources investment for community chronic kidney disease service was limited,which restricted the development.2.2 Service user(community residents)(1)Basic condition of residents:996 returned lists for investigation were valid.The major objects of this investigation were female,over 60 years old,married,individual investor and self-employed,below junior middle school education level,low income residents,the system of medical insurance for urban workers and annual check-up.Majority of them considered themselves in good health.None of them had been diagnosed as hypertension,diabetes and chronic kidney disease patients.(2)Influencing factors of awareness of chronic kidney disease:The screening positive rate of degree of chronic kidney disease risk was 14.46 percent.The good rate of community health services utilization was 11.95 percent.42.54 percent chose see a doctor to the community health service center because "it's more convenient than hospital." In community health service satisfaction,only 15.56 percent were satisfied with the work of community health service centers.Only 9.33 percent of the chronic kidney disease needs are good for community CKD.According to the results of investigating,the residents had the highest regard for medical equipment,the doctor's treatment and service attitude,about 71.99 percent,78.11 percent and 70.98percent.Respondents once confirmed may suffer from chronic kidney disease,61.86 percent choice to tertiary hospital regularly to avoid disease,and 20.44 percent choice to participate in community follow-up regularly to prevent disease.2.3 Service provider(four community health service centers in urban zone)(1)There were no staff of chronic kidney disease health service,personnel lack of understanding to chronic kidney disease and human resources very deficient.Lack of primary screening equipment and funds in community health service centers.They also don't have enough power to provide chronic kidney disease health service.(2)Only a small number of community health service centers have chronic kidney disease health education,but there weren't targeted education,and lack of practicable system and reference for overall management of chronic kidney disease in Kunming community.3 To analyze influencing factors of awareness of chronic kidney disease(1)Single factor analysis:Single factor analysis showed that the respective difference of awareness between different education level,occupation,family average monthly income,health insurance,frequency of physical examination,community health service utilization,chronic kidney disease demand,community satisfaction evaluation,and understanding of chronic kidney disease prevalence situation,P<0.05.Below junior middle school education level,farmers and low-income people,New Rural Cooperative Medical System population,not a medical,community health service needs of chronic kidney disease using low population,community health service utilization poor population,community satisfaction poor population and people don't know the prevalence of chronic kidney disease had lowest awareness in their groups.(2)Multiple factors analysis of the definition and stagingOrdered logistic regression analysis showed that the equation is not formed and no influence factors enter the equation.(3)Multiple factors analysis of clinical manifestationsOrdered logistic regression analysis showed that sex was awareness influencing factors for clinical manifestations of chronic kidney disease[man(OR = 0,738,P<0.05)],it means the higher the men awareness of chronic kidney disease better than women.Chronic kidney disease demand is awareness influencing factors for clinical manifestations of chronic kidney disease[poor(OR = 2.259,P<0.05),the general(OR =2.214,P<0.05)],it means the higher the use of chronic kidney disease demand,the better of awareness.The cognition to the prevalence of chronic kidney disease is a resident of awareness influencing factors for clinical manifestations of chronic kidney disease[don't know(OR = 2.276,P<0.01)and low(OR = 2.085,P<0.05),the general(OR = 1.598,P<0.05),characterized by that the residents of the high prevalence of chronic kidney disease on the level of knowledge about clinical manifestations of chronic kidney disease is about low don't know,and generally 2.276 times,2.085 times and 1.598 times,which holds that the higher the prevalence of chronic kidney disease,the better of awareness.(4)Multiple factors analysis of the risksOrdered logistic regression analysis showed that sex was awareness influencing factors for risks of chronic kidney disease[man(OR = 0,735,P<0.05)],it means the higher the men awareness of chronic kidney disease better than women.Community health service utilization is awareness influencing factors for risks of chronic kidney disease[poor(OR = 1.684,P<0.05),the general(OR =1.665,P<0.05)],it means the higher the use of community health service utilization,the better of awareness.The cognition to the prevalence of chronic kidney disease is a resident of awareness influencing factors for risks of chronic kidney disease[don't know(OR = 3.251,P<0.01)and low(OR = 2.067,P<0.05),the general(OR = 1.511,P<0.05),characterized by that the residents of the high prevalence of chronic kidney disease on the level of knowledge about risks of chronic kidney disease is about low don't know,and generally 3.251 times,2.067 times and 1.511 times,which holds that the higher the prevalence of chronic kidney disease,the better of awareness.(5)Multiple factors analysis of general awarenessOrdered logistic regression analysis showed that community health service utilization was awareness influencing factors for chronic kidney disease[poor(OR =1.622,P<0.05),the general(OR = 1.611,P<0.05),it means the higher the use of community health services,the better of awareness.Chronic kidney disease demand is awareness influencing factors for chronic kidney disease[poor(OR = 2.188,P<0.05),the general(OR = 1.849,P<0.05)],it mentis the higher the use of chronic kidney disease demand,the better of awareness.The cognition to the prevalence of chronic kidney disease is a resident of awareness influencing factors for chronic kidney disease[don't know(OR = 4.787,P<0.01)and low(OR = 2.413,P<0.01),the general(OR = 1.713,P<0.01),characterized by that the residents of the high prevalence of chronic kidney disease on the level of knowledge about chronic kidney disease is about low don't know,and generally 4.787 times,2.413 times and 1.713 times,which holds that the higher the prevalence of chronic kidney disease,the better of awareness.Conclusions:1 Kunming haven't been enough paying attention on chronic kidney disease health service,there is no institutional guarantee for its management.2 Chronic kidney disease health service of Kunming is developed in certain extent,but not comprehensive enough.3 Community health service centers haven't been enough power to provide chronic kidney disease health service.4 Lacking the understanding of chronic kidney disease of Kunming community residents,the awareness of disease prevention is poor.5 Influencing awareness of chronic kidney disease main are sex,awareness of chronic kidney disease prevalence,community health services utilization,and community chronic kidney disease demand.Suggestions:1 Increasing the importance of chronic kidney disease to health worker,establish and perfect the supporting policies and regulations.2 Constructing and improving the system of management chronic kidney disease in community.3 Increasing the investment for community chronic kidney disease service.4 Increasing the awareness of chronic kidney disease prevention to community residents.5 Improving community chronic kidney disease health service quality,increasing community health service utilization rate.6 Increasing the individuality chronic kidney disease knowledge education from community health service centers,expanding the way of chronic kidney disease knowledge. |
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