西安市某社区的社区诊断模式及应对策略

The diagnostic model and control strategies of a community in Xi'an City

目的发现社区主要健康问题及其危险因素;调查居民健康需求及其卫生知识水平;分析本社区优先干预的卫生问题;制定本社区卫生服务工作规划,并为社区卫生服务的综合效果评估提供基线数据。方法采用横断面调查设计,随机整群抽样,结构式问卷居民现场填写方式,对常住人口的一般状况、慢性病知识的知晓情况、患病率及特殊人群(老年人、儿童)的生活状况进行调查分析。结果常住人口老年人比例高,50～60岁以上人群占总常住人口的24.8%;人群文化水平普遍较低,以初中、高中文化程度为主,大学及以上学历者仅为13.2%,无业人员和离退休人员占的比例高达49.1%;家庭收入偏低,社区居民家庭平均月收入为5 455元/户,用于药品、医疗支出为5 660元/户,其中自费支出平均3 780元/户;被调查老年人群慢性病的患病率较高,最常见的分别是高血压(14.5%)、糖尿病(4.2%)、冠心病(2.9%)、脑卒中(2.4%);常住居民的高血压发病率为17.1%,高血压患者的服药率为64.3%(11/17.1),服药后血压控制率为63.6%(7/11);常住人口高危人群BMI、腰围、血压正常高值超标比例均为女性高于男性,分别为19.5%、9.5%、30.6%;被调查者行为危险因素,男性居民以吸烟、少动、喜欢吃较咸食物,女性以少动、喜欢吃较咸食物为主要行为危险因素;高盐饮食人群中,高血压的患病率高达到了21.3%,显著高于中国总人群的高血压患病率(13.58%),u=9.277,P<0.05;出现身体不适,而选择就医场所时,28.4%的人选择三级医院或专科医院;因病住院者59.4%集中在三级医院或专科医院;被调查者中60岁以上老人居住条件、自我满足感、家庭关系较好者均占50%以上,60%以上的老年人对自己的经济条件和健康状况不满意,45.8%的老年人睡眠质量较差,46.6%老人日常生活无法摆脱药物,且62.9%老人存在"空穴"家庭问题;6岁以下儿童的儿童保健、家长对儿童健康行为管理均高于80%,7～17岁儿童的家长对儿童健康行为管理率高达94.7%,而亲子关系的亲密度亦高达73.9%。结论社区居民的健康意识仍然需要进一步提高,社区应更广泛地宣传普及健康知识。关注老年人、儿童等弱势群体的生活质量,更好地开展以社区卫生服务中心为主导的慢性病防控策略。

Objective To explore the major health problems and risk factors in the community, investigate the health demand and health knowledge of the residents, analyze the priority intervention of community health prob- lem, and provide baseline data for evaluation of the comprehensive effects of community health services. Methods Cross-section survey was designed, random cluster sampling was conducted, and structured questionnaires were distributed to investigate the general situation of the residents, the awareness of chronic diseases, prevalence and liv- ing condition of special groups （the elderly and children）. Results The elderly aged 50~60 accounted for 24.8% of permanent resident population. These people had low degree of education and low family income. The prevalence of chronic diseases was high, including hypertension （14.5%）, diabetes （4.2 %）, coronary heart disease （2.9 %）, and stroke （2.4%）. Of all permanent residents, the prevalence of hypertension was 17.1%, the medication ratewas 64.3 % （11 / 17.1 ）, and the blood pressure control rate after taking the drug was 63.6 % （7/11）. The main risk factors of male residents were smoking, hypo-motility and high salt diet. High risk factors of women included little exercise and high salt diet. The prevalence of hypertension reached 21.3 % in high salt diet group, which was signifi- cantly higher than China＇s total population prevalence of hypertension （13.58%）, u = 9. 277, P〈 0.05. 28.4% of people chose comprehensive hospitals or specialized hospitals when they were ill, and 59.4% were hospitalized in such hospitals. More than 50% people older than 60 years were satisfied with their living conditions and family rela- tionship. More than 60% were not satisfied with their economic conditions and health. 45.8% had poor sleeping quality. 46.6 % took drugs daily. 62.9 % had no children living with them. 80% parents cared about the health and behavior management of children younger than 6 years old, 94.7% parents did so to children 7 to 17 years old, and 73.9%families had close parent-child relationship. Conclusions The health consciousness of community residents needs to be further improved and the health education and promotion should be strengthened in communities. More attention should be paid to the quality of life of the vulnerable groups, including the elderly and children. Chronic diseases prevention and control should be better carried out in community health service center.