Community-based intervention of chronic disease management program in rural areas of Indonesia

Objective:This study evaluates the community-based intervention of chronic disease management(CDM)through the Integrated Non-Communicable Diseases Health Post(Posbindu-NCD)conducted by a community of health workers(CHWs)in Indonesia’s rural areas.Methods:A cohor t retrospective study evaluated 577 par ticipants from Posbindu-NCD in 7 public health centers(PHCs)in 2019.Activities of intervention of CDM for Posbindu-NCD was included,identified risk factors to NCDs,and provided counselling education and other follow-ups based on interviews and measurement results from the five Desk systems that recorded in a medical record as a form of the monthly activity report each the first month,the 6 months,and the 12th month.Results:There were statistically significant differences for alcohol consumed and diabetes mellites(χ^(2)=10.455;P=0.001).There were significant differences on gender(χ^(2)=3.963;P=0.047),on ethnicity(χ^(2)=19.873;P<0.001),and hypertension.In addition,there were also significant differences on ethnicity(χ^(2)=15.307;P<0.001),vegetable consumption(χ^(2)=4.435;P=0.035),physical exercise(χ^(2)=6.328;P=0.012),and the current diseases of hypercholesterolemia of par ticipants.Fur thermore,the survival rate among patients who have overweight,abdominal overweight,hyper tension,diabetes mellitus,and hypercholesterolemia increased among par ticipants who regularly visited Posbindu-NCD compared with the non-regularly one.Conclusions:The CDM program’s community-based intervention through Posbindu-NCD conducted by CHWs improved survival rates in Indonesia’s rural areas.Therefore,this program can be fur ther developed in conducting CDM in the community with the active involvement of CHWs so that the community becomes active regularly in par ticipating in Posbindu-NCD activities in rural areas of Indonesia.

Community Pharmacist-Based Collaborative Disease Management Program for Patients with Poorly Controlled Diabetes

Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementation of an employer initiated community pharmacist-based disease management program for diabetic patients with poorly controlled diabetes. Methods： Employees with poorly controlled diabetes （glycosylated hemoglobin （A1 C） level 〉 7.5%） were identified fi＇om a large diabetes disease management program, in a rural setting in Texas, US. A longitudinal retrospective study was conducted, analyzing clinical indicators in the diabetes patients following the community pharmacist-based disease management program. The program involved a comprehensive drug therapy assessment and individualized disease management education. Primary outcome measured in the present study was A1C levels, assessed at the baseline visit and at the end of the intervention. Results： A total of 64 patients with poorly controlled diabetes were identified. Significant improvement in mean clinical outcome scores was achieved for A1C levels （p = 0.0011）. At the end of the 1 year longitudinal intervention, targeted body mass index and A1C goals were attained by 35.9% （p 〈 0.001） and 15.6% patients, respectively. The 10 patients reaching goal levels post intervention were in the group that had baseline A1C of 7.5 to 9%. However, patients with 〉 9% A1C levels at baseline had a significant reduction （mean 2.1, p 〈 0.001） post intervention. Conclusion： The community pharmacist-based diabetes disease management program improved A1C levels of patients with poorly controlled diabetes.

抗菌药物分级管理与结果分析

目的了解抗菌药物分级管理干预措施的实施及效果。方法从医院信息系统抗菌药物分级管理子系统中采集干预前和干预后两组出院患者的抗菌药物使用信息,对其进行回顾性比较及分析。结果干预后组和干预前组比较,抗菌药物使用率、人均抗菌药物费用、人均抗菌药物使用频次、二线(三线)抗菌药物使用比例均显著减少。但各病区执行情况有差异,第三代头孢类抗菌素用量较大。结论实施分级管理有利于抗菌药物的合理使用,但管理措施应进一步加强。

抗菌药物分级管理与结果分析

目的:了解抗菌药物分级管理干预措施的实施及效果。方法:从医院信息系统抗菌药物分级管理子系统中采集干预前和干预后两组出院患者的抗菌药物使用信息,进行回顾性比较及分析。结果:干预后组和干预前组比较,抗菌药物使用率、人均抗菌药物费用、人均抗菌药物使用频次、二线、三线抗菌药物使用比例均显著减少。但各病区执行情况有差异,第三代头孢类抗菌素用量较大。结论:实施分级管理有利于抗菌药物的合理使用,管理措施应进一步加强。

上海市崇明县农村实行高血压分级管理在预防心脑血管疾病中的效果

目的探讨按照不同高血压水平对病人进行管理,评价其在预防心脑血管疾病中的作用。方法采用随机抽样的方法,将普查出的高血压病人随机分成对照组和实验组,对实验组按高血压水平进行三级管理干预。结果对照组的理想血压控制水平远远低于实验组,对照组心脑血管疾病发病率和血压水平有正相关性(r=0.71),理想血压控制水平在65岁时最高。结论在农村地区,推广高血压三级管理,可以用很少的投入,取得明显的预防效果。

社区高血压、糖尿病分级管理干预后心电图改变的研究价值

目的探讨分级管理干预对社区高血压、糖尿病患者心电图改变的效果。方法选取社区内180例高血压及90例糖尿病患者,随机分为对照组及干预组。对照组给予常规管理,干预组按照危险程度将高血压及糖尿病患者均分为高危、中危、低危三组,给予相应管理。随访半年后比较两组患者心电图情况。结果高血压、糖尿病患者对照组心电图异常率分别为42.2%、46.7%,干预组分别为13.3%、15.6%,显著低于对照组(P<0.05,P<0.05)。结论社区分级管理模式有利于社区控制高血压、糖尿病,改善患者生活质量,值得推广。