2010年中国五省社区高血压患者就诊机构和医疗保障的现状及城乡比较

Current status and urban-rural comparison of clinical agency of detection, management, and health insurance for hypertensive patients in communities of five provinces in China in 2010

目的通过对2010年中国5个省城乡社区高血压患者就诊机构、就医现况和医疗保障的比较，旨在为国家基本公共卫生服务项目高血压患者健康管理的实施和效果评估提供基础性数据。方法于2010年，在我国江苏、山东、河北、四川和甘肃5个省，主要根据经济发展水平，依次抽取市、区县，最终确定10个调查点。采用整群抽样方法，在每个调查点抽取3-4个社区或乡镇，调查符合标准的社区高血压患者8326例，其中城市4363例，农村3963例，针对城乡高血压患者的就诊机构、就医现况和医疗保障情况进行比较。结果城市社区高血压患者首次诊断机构主要为区（县）级及以上医院（43．74％，1867／4268），社区卫生服务中心（25．07％，1070／4268）和社区卫生服务站（20．20％，862／4268）分列第2、3位；复诊机构以社区卫生服务中心（30．72％，1274／4147）和社区卫生服务站（31．11％，1290／4147）为主；药物主要来源于药店（60．23％，3073／5102）。农村社区居民高血压首次诊断机构主要为村卫生室（54．58％，2133／3908），乡镇卫生院（22．36％，874／3908）和区（县）级及以上医院（18．86％，737／3908）分列第2、3位；复诊机构以村卫生室（70．49％，2695／3823）为主；药物主要来源于村卫生室（46．23％，2116／4577）和药店（36．29％，1661／4577）。我国城乡社区居民选择高血压复诊机构的主要原因为离住所近（方便）（45．79％，6276／13706）和价格低（11．78％，1614／13706）。城市社区居民既往1年高血压相关住院费用的报销比例为66．67％，高于农村居民（35．71％）（Z=-12．13，P〈0．01）；城乡社区居民既往1年高血压相关治疗总费用（包括门诊和住院费用）报销比例分别为34．78％和9．50％（Z=-17．56，P〈0．01）。结论我国应进一步推进社区高血压筛查与门诊血压检测制度，提高社区层面首诊检出率；加强基层医疗机构建设，便利患者降血压治疗需求，促进高血压防治。

Objective To investigate the status of the clinical agency of detection, management,and health insurance for hypertensive patients in urban and rural communities of five provinces in China in 2010,in order to provide fundamental data for implementation and evaluation of community health management of hypertensive patients in basic public health service. Methods From Jiangsu, Shandong, Hebei, Sichuan and Gansu provinces, cities and districits （counties） were selected according to economic development level and 10 survey sites were finally determined. In each survey site ,3 -4 communities or townships were selected by cluster sampling methods in 2010. A total of 8326 eligible hypertensive patients （4363 in urban and 3963 in rural） were included. The urban-rural difference of clinical agency and health insurance was compared for hypertensive patients. Results In urban areas, 43.74% （1867/4268） hypertensive patients were first diagnosed at hospitals of district level or above,25.07% （1070/4268） at community health service centers （ CHSC）, and 20. 20% （ 862/4268 ） at community health service stations （ CHSS）, respectively ; 30. 72% （1274/4147） and 31.11% （1290/4147） patients chose CHSC and CHSS for their follow-up visiting, respectively; 60. 23% （3073/5102） antihypertensive medication was obtained from pharmacies. In rural areas,54.58% （2133/3908） hypertensive patients were first diagnosed at village clinics, 22.36% （874/3908） at township hospitals, and 18.86% （737/3908） at hospitals of county level or above; 70.49% （2695/3823） patients chose village clinics for their follow-up visiting; 46.23% （2116/4577） antihypertensive medication was obtained from village clinics, and 36.29% （1661/4577） from pharmacies. The main reasons for choosing clinical agency for both urban and rural patients were convenience （45.79% ,6276/13 706） and low cost （11.78%, 1614/13 706）. The proportions of reimbursements for hospitalization expenses and total medical expenses for hypertensive patients in urban in the past year were 66. 67% and 34. 78% ,respectively,which were much higher than those in rural （35.71% and 9. 50% ） （Z value was - 12. 13 and - 17.56, P 〈 0. 01 ）. Conclusion Community-based hypertension detection and routine blood pressure measurement during clinical visiting should be further strengthened to improve early diagnosis of hypertension. The development of community-based clinical agency should be able to provide convenient and low cost health service for hypertensive patients to improve treatment, follow-up and control of hypertension.