2010-2012年长沙市高血压糖尿病社区管理进展及其影响因素分析

An analysis on the progress and influencing factors of the community based management for hypertension and diabetes in Changsha from 2010 to 2012

目的对2010-2012年长沙市高血压、糖尿病社区管理进展评估及影响因素分析。方法采用2010-2012年疾病监测、年度报表、专项调查等数据进行统计分析。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果疾病监测:心脑血管疾病在居民死因谱构成持续占据首位。年度报表:2012年末高血压患者平均健康建档率40.98%,规范管理率77.96%;糖尿病患者平均健康建档率36.20%,规范管理率81.39%。专项调查:居民中存在慢病主要危险因素:肥胖率城区7.9%,乡镇12.5%;吸烟率城区27.9%,乡镇48.9%;空腹血糖受损(IFG)率平均为9.1%;糖尿病患病率平均为6.5%。高血压患者社区管理一年后血压控制率城区50.0%,乡镇20.5%;城乡差异有统计学意义(χ2=19.903,P<0.01)。结论长沙市高血压、糖尿病患者建档率、规范管理率和控制率逐年提高;社区管理后慢病群体受益效果初步显现。目前慢病社区管理仍存在专业人员少、经费不足、管理软件不兼容等影响因素;需要建立以政府主导、多部门协作、专业机构指导和全社会参与的工作机制,促进慢病社区管理可持续发展。

Objective To evaluate the progress of community based management for hypertension and diabetes in Changsha from 2010 to 2012, and to analyze the influencing factors. Methods Data collected from disease surveillance, annual report, and special survey during 2010 to 2012 were analyzed. Chi-square test was used for statistical analysis. Results Based on data from disease surveillance, cardiovascular disease was still the number one death cause for residents. Analysis of annual report data showed that by the end of 2012, the health record rate and the standardized management rate for hypertension patients and patients with diabetes were 40.98%, 77.96% and 36.20%, 81.39%, respectively. Meanwhile, according to the specific survey, more residents from rural areas were obese or smoke compared with those from urban areas （12.5 % vs 7.9 % ; 48.9% vs 12.5%）, which were major risk factors for chronic diseases. The overall average IFG rate was 9.1 % and the prevalence of diabetes was 6.5 %. The blood pressure control rates among patients with hypertension one year after the community based management was 50% in urban areas and 10% in rural areas, the difference was significant （P〈0.01）. Conclusions The community based management can effectively increase the health record rate, standardized management rate and control rate for patients with hypertension and diabetes in Changsha. But factors as lack of professional personnel, shortage of funds and incompatible management software still influence the community based management for chronic disease, it is critical to establish a work system with government led, multi-departments collaboration, professional guidance and the whole society involved in order to sustain the accomplishment of community based management for chronic disease.