2018年辽宁省高血压和糖尿病患者基本公共卫生服务现状分析

Analysis of Basic Public Health Services for Patients With Hypertension and Diabetes in Liaoning Province in 2018

目的分析辽宁省基本公共卫生服务项目中高血压和糖尿病患者健康管理服务存在的问题及原因,为进一步规范健康管理服务提供科学依据。方法采取多阶段分层随机抽样方法,在全省14个市中分别抽取28家社区卫生服务中心和28家乡镇卫生院,在每个机构等距抽取高血压和糖尿病患者健康档案各10份开展电话调查,核查档案表单、体检记录、随访记录等,根据国家基本公共卫生服务规范判定档案信息准确性和服务规范性,记录最后一次随访时的血压/血糖,计算血压/血糖控制率,并进行描述性分析。结果高血压和糖尿病患者估算健康管理率分别为37.3%和39.9%,档案信息准确率分别为91.1%和90.7%,服务规范率分别为37.5%和38.0%,血压/血糖控制率分别为75.3%和71.6%。高血压和糖尿病患者健康管理服务的合计不规范项中,占比最高的分别为患者未体检中的不知道/未通知(41.4%)、患者未随访中的不知道/未通知(56.4%)、服务内容不规范中的未提供体检(30.0%)、体检记录不规范中的现存主要健康问题未填写(27.6%)和随访记录存在空漏错项中的生活方式指导(34.4%)。高血压和糖尿病患者健康管理服务满意度分别为98.3%和98.1%。结论辽宁省高血压和糖尿病患者档案信息准确性较好,仍需进一步提高健康管理率和服务规范率。

Objective To analyze the problems and its causes of health management services for patients with hypertension and diabetes in the basic public health service project in Liaoning Province in order to provide scientific basis for further standardizing health management services.Methods A multi-stage stratified random sampling method was used to select 28 community health service centers and 28 township health centers in 14 cities. Then,telephone surveys was conducted by equidistant sampling of 10 patients with hypertension and diabetes at each of the selected centers. Archival forms, physical examination and follow-up records were checked in order to determine the accuracy of archival information and service standardization according to the national standards for basic public health service. Blood pressure and glucose levels were checked at the last follow-up,and the control rate of blood pressure and glucose was calculated. Results The estimated health management rates for patients with hypertension and diabetes were 37.3% and 39.9%. The accuracy rates of the file information were 91.1% and 90.7%,the service standardization rates were37.5% and 38.0%,and the blood pressure and glucose control rates were 75.3% and 71.6%. Among the total non-standardized items of health management services for patients with hypertension and diabetes,the following items were noteworthy due to its high proportion:patients was unknown or not informed in the physical examination section(41.4%),patients were unknow or not notified in the follow-up section(56.4%), failure to provide medical examinations(30.0%) in the service section, major health problems were not filled out in the physical examination section(27.6%),and missing lifestyle guidance(34.4%) in the follow-up record section. Satisfaction rates with health management services for patients with hypertension and diabetes were 98.3% and 98.1%. Conclusion The accuracy of archive information of patients with hypertension and diabetes is relatively good in Liaoning Province, and the rate of health management and service standardization needs to be further improved.