我国内地高血压管理运行机制现状及对防控效果的影响

Current status of hypertension management operation mechanisms in Chinese mainland and their impact on prevention and control effects:an analysis on official documents

目的评价我国内地高血压防控管理运行机制现状,并探索其完善程度对高血压防控效果的影响,为提升高血压防控管理水平提供参考依据。方法收集2000年1月1日—2018年12月31日我国内地31个省(自治区、直辖市)与高血压防控相关的政策文件,依据适宜公共健康体系评价模型及标准系统评价我国内地高血压防控管理运行机制现状,并运用logistic回归模型分析管理运行机制完善程度对高血压防控效果的影响。结果2018年我国内地高血压防控管理运行机制适宜程度为43.68%,较2000年提升了21.64%,与适宜标准仍存在48.61%的差距。其中,协调与激励机制适宜程度最低(14.03%),计划与评价机制适宜程度最高(63.04%)。从具体定位看,中长期规划覆盖程度(100.00%)、内容形式完备程度(94.45%)适宜程度较高,管理机制可行程度仅为9.76%。logistic回归分析结果显示,管理运行机制的完善有助于控制高血压患者血压(OR=1.012,P=0.007)和保持患者血压稳定性(OR=1.010,P=0.029)。结论2000—2018年我国内地高血压防控管理机制建设趋于完善,有效地推动了高血压防控管理水平的提升,但仍需进一步建立健全协调与激励机制并明晰部门职责分工。

Objective To evaluate the current status of hypertension prevention and control management operation mechanisms in Chinese mainland,explore the impact of their improvement on hypertension prevention and control effects,and provide a reference for enhancing hypertension prevention and control management.Methods Policy documents related to hypertension prevention and control from January 12000 to December 31,2018 in 31 provinces(municipalities and autonomous regions)in Chinese mainland were collected.The current status of hypertension prevention and control management operation mechanisms in Chinese mainland was systematically evaluated according to the appropriate public health system evaluation model and standard.A logistic regression model was used to analyze the impact of the improvement of management operation mechanisms on hypertension prevention and control effects.Results In 2018,the appropriateness of hypertension prevention and control management operation mechanisms in Chinese mainland was 43.68%,with an increase of 21.64%compared to 2000,but there was still a gap of 48.61%from the appropriate standard.Among them,the appropriateness of coordination and incentive mechanisms was the lowest(14.03%),and the appropriateness of planning and evaluation mechanisms was the highest(63.04%).In terms of specific positioning,the coverage of medium and long-term plans(100.00%)and the completeness of content and form(94.45%)were relatively high,while the feasibility of management mechanisms was only 9.76%.The results of logistic regression analysis showed that the improvement of management operation mechanisms helped control blood pressure in hypertensive patients(OR=1.012,P=0.007)and maintain the stability of patients’blood pressure(OR=1.010,P=0.029).Conclusion From 2000 to 2018,the construction of hypertension prevention and control management mechanisms in Chinese mainland tended to be improved,effectively promoting the improvement of hypertension prevention and control management levels.However,it is still necessary to further establish and improve coordination and incentive mechanisms and clarify the division of departmental responsibilities.