江门市慢性病患者社区健康管理现况调查

Investigation on community health management of patients with chronic diseases in Jiangmen

目的分析基层医疗机构提供的慢性病患者健康管理服务和患者对服务利用的情况及其影响因素,为完善社区健康服务体系提供科学依据。方法随机抽样采用电话和问卷调查,采用SAS9.4统计软件进行数据分析。结果慢性病患者对社区健康管理的知晓率为80.62%,接受率为67.05%;健康管理内容以测量血压/血糖、生活指导、用药指导、体格检查和随访最为多见。64.94%的基层医疗卫生机构配备7人或以上相关工作人员,但仅有29.87%的机构设置了3人或以上专职管理慢性病患者健康管理工作;93.51%医疗卫生机构慢性病健康管理工作存在难度。结论江门市开展的社区慢性病健康管理服务得到了社区居民的认可,通过改善人力资源配置,整合社会力量,提高管理服务质量和精准宣教,进一步完善社会健康服务体系。

Objective To analyze the health management services for the patients with chronic diseases provided by primary medical institutions and the utilization of services by the patients and its influencing factors,so as to provide scientific basis for improving community health service system.Methods Random sampling was adopted,telephone and questionaire survey were conducted and SAS 9.4 statistical software was used for data analysis.Results The awareness rate of the patients with chronic diseases to community health management was 80.62%,and the acceptance rate of community health management was 67.05%;blood pressure/blood glucose measurement,life guidance,medication guidance,physical examination and follow-up visit were the most common contents of health management.About 64.94%of the primary medical and health institutions were equipped with 7 or more relevant staff,but only 29.87%of the institutions had 3 or more full-time staff to deal with the health management of the patients with chronic diseases;about 93.51%of the medical and health institutions had difficulties in the health management of chronic diseases.Conclusion The community health management services for chronic diseases carried out in Jiangmen City have been recognized by the community residents,the social health service system could be further improved by improving the allocation of human resources,integrating social forces,improving the quality of management services as well as accurate publicity and education.