Study On The Status Quo And Influencing Factors Of Hierarchical Medical System Of Hypertension And Diabetes In Zhuhai

1 ObjectiveUnderstanding the status quo and problems of hierarchical medical system based on hypertension and diabetes in Zhuhai.From the perspective of hypertensive patients and diabetics,we compared and analyzed the attitudes,demands,and feelings of patients including knowing and not knowing,sign-up and non-signing the system.From the perspective of medical personnel,we compared and analyzed the perceptions and attitudes of health care personnel of medical institutions and medical staff of medical institutions at higher levels to lay the foundation for the promotion of hierarchical medical system in Zhuhai to other diseases,to better build hierarchical medical system and rationally allocate and use medical resources.To make relevant policies will provided a scientific basis for reference.2 Method(1)Sources:literature review,questionnaires,and in-depth interview method.(2)Survey method:Using a multi-stage sampling method,978"two-diseases"patients from the Xiangzhou District,Doumen District,and Jinwan District of Zhuhai were selected to conduct a questionnaire survey,among which 968 were valid questionnaires,and the efficient rate was98.98%;By stratifying cluster random sampling method,a total of 274 medical staff from different medical institutions in Zhuhai were selected to conduct a questionnaire survey,of which253 were valid questionnaires and the efficient rate was 92.34%.(3)Statistical methods:One-factor rank sum test,chi-square test analysis method,and logistic regression analysis method were included.3 Results(1)A total of 968 patients with"two diseases"were analyzed in this study,including 441patients(45.56%)in Xiangzhou District,357 patients(36.88%)in Doumen District,170 patients(17.56%)in Jinwan District,and 506 men(52.27%),462 women(47.73%);584 patients(60.33%)over 60 years old,293 patients(30.27%)aged 45-59,88 patients(9.09%)aged 30-44,and 3 patients(0.31)under 30 years old;The vast majority of patients were Han nationality,with963(99.48%),5 minorities(0.52%);elementary school and below(including illiteracy,primary school)373 patients(38.53%),junior high school 278 patients(28.72%),high school or technical secondary school 206 patients(21.28%),college,undergraduate and above 111 patients(11.47%);monthly income below 2000 yuan 367 patients(37.91%),2000 to 4000 yuan 332patients(34.30%),4000~6000 yuan for 165 patients(17.05%),6000~8000 yuan for 41 patients(4.24%),8000~10000 yuan for 27 patients(2.79%),10,000 yuan for more than 36 patients(3.72%).There were 915 patients with medical insurance(94.52%),no medical insurance 53patients(5.48%);only 532 patients(54.96%)with hypertension,only 201 patients(20.76%)with diabetes,both with hypertension and diabetes 235 patients(24.28%);Except for hypertension or(and)diabetes,617 patients(63.74%)had other chronic diseases,and 351 patients(36.26%)had no other chronic diseases;There were 833 patients(86.05%)in the institution,111 patients(11.47%)in the non-established primary health care institutions,and 24 patients(2.48%)in the unknown.(2)According to the logistic regression model,the independent factors affecting the knowing of“two diseases”patients of the hierarchical medical system of the“two diseases”were administrative area,average monthly income,when the disease was severe,the first choice of medical institution,and whether there was a primary level medical experience.(3)According to the logistic regression model,the independent factors affecting the signing of“two diseases”patients of the hierarchical medical system of the“two diseases”were administrative area,occupation,whether there was fixed-point medical institutions,when the disease was severe,first choice of medical institution,and whether there was a primary level medical experience.(4)There was no significant difference in awareness rate of the hierarchical medical system among different medical institutions(?~2=2.721,P=0.099).(5)The primary health care institutions medical staff and superior hospital medical staff all believe that drug and medical equipment was not fully provided,patients did not trust the medical staffs working in primary health care institutions and the lack of information communication between medical institutions was the main factor affecting the hierarchical medical system of“two diseases”in Zhuhai.Both of them have significant differences in the frequency of follow-up visits by the medical staff.The medical staff at the primary health care institutions tend to believe that the medical staff's frequent follow-up of patients was an important factor affecting the hierarchical medical system of“two diseases”in Zhuhai.More than 50%of primary health care institutions medical and nursing staff,superior hospitals medical and nursing staff believe that the primary health care institutions should better meet the demands of the masses,increase the reimbursement rate of medical expenses,expand the basic drug catalogs,improve the medical staff's operational capacity,and increase the level of basic equipment and facilities,enhance publicity on the primary health care institutions.There was a statistically significant difference between the two in the expansion of basic drug catalogs and the promotion the publicity.(P<0.05)4 ConclusionHierarchical medical system based on hypertension and diabetes in Zhuhai has been implemented for a period of time and has begun to take effect.But the effect was not particularly obvious.To form a real hierarchical medical system,there were still areas for improvement:the awareness rate of patients needed to be improved;patients with“two diseases”had higher willingness of refer but lower referral rate;the service capacity of primary-level medical institutions was insufficient;the lack of general practitioners.Suggestions:we should strengthen the promotion of hierarchical medical system;strengthen the cooperation between primary health care institutions and hospitals to improve the referral rate of patients;expand the drug directory of primary medical institutions properly and extend the time of prescriptions for patients;strengthen the training of general practitioners..