Community Diabetes Management And Its Effect Analysis In Beilin District Of Xi’an City Under Graded Diagnosis And Treatment Policy

Objective:To understand the status of community diabetes health management in Berlin District of Xi’an under the graded diagnosis and treatment policy,to preliminarily evaluate its management effect,to analyze its existing problems and influencing factors,and to put forward relative suggestions.Methods:Questionnaire survey was used to investigate community health institutions,managed diabetes patients and community diabetes managers.Retrospective study was used to collect health records of sampled patients,and in-depth interview was used to interview diabetes managers separately.Results:1)9 community health service centersAll institutions have established chronic disease-related management departments.Diabetes full-time managers and commonly used testing equipment are basically well equipped.Most of the hypoglycemic drugs are metformin and alpha-glycosidase inhibitors.In 2017,diabetes outpatient service accounted for 8.25%and 5.11%-9.98%among institutions.The total number of transfers was 3131.Joint ventures accounted for a large proportion(94.12%)and services were poor.Only two organizations accepted transfers(14,94).Diabetes referral service is directly proportional to the overall referral level of institutions,with 709 referrals up and no statistics on referrals down.In 2017,The total health management rate,standardized management rate,blood sugar control rate and lost visits rate of diabetes mellitus were 28.25%,72.53%,61.98%and 7.11%.The interagency rates ranged from 20.50%to 37.19%,61.68%to 86.67%,41.42%to 88.04%,and 0.61%to 16.21%.2)585 diabetic patients enrolled in community health managementThe overall level of self-management knowledge,belief and behavior is in the middle level,with a total score of(68.68±13.90).The scores of knowledge,attitude and behavior are(70.30±16.82),(78.56±11.67)and(63.01±12.05).The level of education and years of management have an impact on the overall level of self-management.The control levels of blood sugar,blood pressure,BMI,waist circumference and blood lipid were(6.67±1.39)mmol/L,(129.61±11.08/77.03±7.50)mmHg,(24.52±2.91)Kg/m~2,(males 88.45±8.39,females 84.76±8.10)cm,(TC 4.72±1.14)mmol/L,the target rate was 82.2%,88.5%,44.6%,53.5%,18.8%;The level of patient self-management,the length of management and the type of organization have an impact on the achievement of the indicators.3)Community Medical Service Team Building and Diabetes Related ManagersThe medical team of community health service has basically completed the construction requirement of"one general practitioner+one nurse".Other types of medical personnel have poor participation.Of the 40 diabetes-related chronic disease managers sampled,35.0%were satisfied with their work and 30.0%were satisfied with the effect of diabetes management.They believed that the service ability of grass-roots institutions and the referral awareness of patients were the primary reasons for Community first diagnosis and two-way referral service,respectively.Conclusion:1)Under the graded diagnosis and treatment policy,the construction of community diabetes management medical service in Beilin District of Xi’an City basically meets the requirements of meeting the standards,but there are some problems such as insufficient resources,poor referral service,and differences in interagency management level.2)Community diabetes health management can help patients improve their self-management level,the rate of health indicators reaching the target,and the satisfaction of community management.However,there are still problems such as poor control of blood lipids,BMI indicators,weak execution ability of health behavior,the gap between the quality and effect of management and patients?expectations.3)The team medical service mode of Community Diabetes has basically formed,But there are some problems,such as insufficient personnel and low job satisfaction.Community diabetes-related chronic disease managers are not satisfied with the effect of diabetes management and the evaluation of their community first-visit and referral medical services.