医防融合下的基层慢性病管理现状分析——以安徽省濉溪县为例

Status quo analysis of grassroots chronic disease management under the integration of medical treatment and prevention:Take Suixi county of Anhui Province as an example

目的以安徽省濉溪为例,分析医防融合下的基层慢性病管理现状进行分析,以提高基层服务质量和服务效果。方法利用濉溪基本公共卫生管理平台慢性病管理数据,以及通过现场调查获得该县村卫生室管理的慢性病患者问卷,分析县域不同医共体背景下的慢性病管理现状、慢性病患者的随访满意情况以及影响因素。结果县中医院医共体的高血压规范管理率和血压控制率以及家庭医生签约率分别比县人民医院医共体高出8.7%,0.53%和5.5%;糖尿病规范管理率和家庭医生签约率分别高出5.06%和10.49%,但是血糖控制率低了1.9%。其中高血压控制率差异不具有统计学意义(P>0.05)。Logistics回归分析的结果显示患病级别、随访次数、服药依从性和有无中医药干预是影响高血压服务满意度的关键因素(P<0.05),随访次数和服药依从性是影响糖尿病患者随访服务满意度的关键因素(P<0.05)。结论基于医防融合的慢性病管理模式具有一定的优势,但仍需要提升基层医生健康随访服务管理质量,给患者提供切实、合理的健康指导和中医药干预下上下功夫,从而保障健康管理服务效果。

Objective To analyze the status quo of grassroots chronic disease management under the integration of medical treatment and prevention by taking Suixi County as an example,so as to improve grassroots service quality and service results.Methods Chronic disease management data of the basic public health management platform in S County were adopted and a questionnaire survey was conducted among chronic disease patients managed by village clinics in the county through field investigation.Both results were used for the analysis of the status quo of chronic disease management in different medical communities of the county,the follow-up satisfaction of the patients,and the influencing factors.Results The standard management rate of hypertension,blood pressure control rate and the contract rate of family doctors in the medical community of the county traditional Chinese medicine hospital were about 8.7%,0.53%,and 5.5%higher than those of the medical community of the county people’s hospital.The standard management rate of diabetes and the contract rate of family doctors were about 5.06%and 10.49%higher there,but the glycemic control rate was about 1.9%lower.The difference in the control rate of hypertension was not statistically significant(P>0.05).The results of Logistic regression analysis results showed that the key factors affecting the satisfaction of hypertension service were the level of disease,the number of follow-up visits,medication compliance,and the presence or absence of traditional Chinese medicine intervention(P<0.05).And the key factors affecting follow-up service satisfaction among diabetes patients were the number of follow-up visits and medication compliance(P<0.05).Conclusions The chronic disease management model based on the integration of medical treatment and prevention has certain advantages,but it is still necessary to improve the management quality of health follow-up service among primary care doctors and provide patients with practical and reasonable health guidance and traditional Chinese medicine intervention so as to ensure the effectiveness of health management services.