Study On The Model Of Chronic Disease Management In Community Health Service In ChengDu City

ObjectiveThe chronic disease have three features of high morbidity rate, high disability rate, high mortality rate. Along with the development of economic and people's living level, chronic patients increased more and more. In 2005 the investigation report of Chinese residents'nourishment and health condition expressed that our country had more than 1.6 hundred million adult hypertension patients. The chronic disease bring heavy disease economy burden to the nation, society, family and the individual, it is urgent to explore cheap and efficient chronic disease management model.To know health service utilization and managemnet of hypertension patients and diabetes millilus in Community Health Centres (CHCs) in ChengDu, and the control condition of the hypertension and diabetes, this research provided basis for related departments to perfect the model of Chronic Disease Management(CDM) by summarizing the experience and discovering problems.MethodsBy combining quantity with quality analyses, this study evaluated the implementation of the model of Chronic Disease Management (CDM) in CHCs in ChengDu. In this study, document analysis, field observation, depth interview, case example research, and comparison research were performed to investigate and analyze the model of CDM in ChengDu. In details, the model and management measures of hypertension patients and diabetes millilus in CHCs were analyzed by document analysis. The utilization rate of hypertension patients and diabetes millilus in CHCs, the control rate of hypertension and diabetes, the awareness, attitude and behavior change rate were analyzed by the descriptive method. The influencing factors were analyzed by chi-square test or unconditional logistic multiple regression analysis. Factor analysis and hierarchical cluster analysis were adopted to study the satisfaction of hypertension patients and diabetes millilus to CHS.ResultsThe results of this study include following:1. The rate of filing health records, standardized-management and the model of CDM in CHCs. In 2006 the rate of filing health records of chronic patients, which include hypertension patients and diabetes millilus, was 28.57%. The rate of standardized-management of high blood pressure, diabetes patients of some area was 55.03% and 54.22%, respectively. In ChengDu the CDM model, which combined management in grades with contractual management, have taken shape.2. The statue of disease control and utilization of CHCs of the hypertension patients and diabetes millilus.①The demographic and sociology characteristic. There were 2028 patients were investigated. Among them,1716 persons are hypertension patients.590 persons are diabetes millilus.278 persons are the hypertension and diabetes patients.821 persons,40.5% are male.1207 persons,59.5% are female. The oldest was 97 years old and the youngest was 14 years old. Average age was 67.10±10.34 years old.②The utilization statue of CHCs:Most hypertension patients and diabetes millilus monitored and treated the disease in CHCs, The rates were 81.41% and 56.95%, respectively. The utilization frequency include four levels:in a week, more than one week in two weeks, more than two weeks in a month, more than a month. More than two weeks in a month was the tallest frequency for both hypertension patients and diabetes millilus. The rates were 44.8% and 47.5%, respectively. It was necessary to shorten the period of monitoring disease for hypertension patients.③The awareness statue of CHCs:The awareness rate of having to take medicine all life once accept medicine treatment of hypertension patients and diabetes patients were 90.0% and 86.9%, respectively. The awareness rate of normal blood pressure and normal blood sugar were 79.4% and 79.2%, respectively. The rates of knowing the right ones were 48.9% and 35.4%, respectively. The all symptoms of diabetes were known by 299(50.7%). It is necessary to strengthen explaining foundational prevention knowledge to the patients.④The rate of complying with General Practitioner(GP)'s advice to take medicine. The rate of complying with GP's advice to take medicine of hypertension patients and diabetes millilus were high,94.7% and 95.1%, respectively. The ones of regularly complying with GP's were 90.9% and 94.2%, respectively.⑤The statue of behavior changes: after being monitored and treated in CHCs, the rate of getting less angry, doing more exercises and living more regularly were 78.0%,76.7% and 93.0%, respectively. The rate of dieting strictly and doing more exercises were 57.1% and 62.1%, respectively.⑥Filing health records and follow-up:There were 1819 persons,89.7% knew their health records was filed.1829 persons,90.2% were followed up by GP. Follow-up in clinic or through telephone, door-to-door follow-up and follow-up in meeting with all residents were three kinds of methods of follow-up. The proportions were 70.7%, 27.0% and 2.3%, respectively.⑦The control rate:The control rate of hypertension and diabetes were 76.3% and 62.5%, respectively.3. Health service satisfaction of CDM. Among the factors, the average score of the satisfaction of service attitude was the highest (4.45), and that of the average doctors'technology level was the lowest (4.00). In overall evaluation of the satisfaction to medical organizations,0.1% of the 2006 patients were "very dissatisfied" or "not too satisfied". Main factor analysis indicated that the 7 factors was reduced to 4. Following hierarchical cluster analysis indicated that the total satisfaction of service, expenses, doctors' technology level, service attitude of visiting patients at home were a set. Procedure of Medical treatment, service attitude of interpreting prevention knowlegde of chronic disease were a set. Medical treatment enviornment, service attitude of seeing a doctor were a set. The later tow sets were merged, and then merged the first set to one set.4. Logistic regression analysis on influencing factors of the CHCs utilization of hypertension patients or diabetes millilus. Age (from 50-year to 69-year), self payment, joining in the Urban Resident. Basic Medical Insurance, awareness of the free charge site of measuring blood pressure, awareness of having to take medicine all life once accept medicine treatment, filing health records and follow-up were protection factors influencing the CHCs utilization of hypertension patients. Not knowing the normal blood pressure was a dangerous factor. Self-payment, joining in the Urban Resident Basic Medical Insurance Scheme, awareness of having to take medicine all life once accept medicine treatment, complying with GP's advice to take medicine, filing health records, follow-up in clinic or through telephone, door-to-door follow-up were protection factors influencing the CHCs utilization of diabetes millilus. Not knowing the normal blood sugar is a dangerous factor.5. Logistic regression analysis on influencing factors of the control rate of hypertension or diabetes. Awareness of the free charge site of measuring blood pressure, awareness of having to take medicine all life once accept medicine treatment, complying with GP's advice to take medicine regularly, strengthening physical exercises, follow-up in clinic or through telephone, door-to-door follow-up were protection factors influencing the control rate of hypertension. Self-employed, joining in the Urban Employee Basic Medical Insurance Scheme, joining in the Urban Resident Basic Medical Insurance Scheme, joining the New Rural Cooperative Medical Scheme were dangerous factors. The employee/worker/attendant, complying with GP's advice to take medicine, strict control of diet were protection factors influencing the control rate of diabetes.6. The measure's features of CDM in CHS in ChengdDu city. The organization of CDM had and its clear-cut job responsibility. The government payed attention to the long-term programme, establishing the policy systematic and in gradation and setting up a check-on index system to cadres and others in CHCs. The contractual management model of the duty doctor's system combined with various forms of health education. A complete and systematic development mechanism of community human resources have been posed, including training, rising in rank, check-on, encourages and so on. Chronic disease information was network and established a early-warning system which was similar to provider reminders. The related research pushed the development of CDM.ConclusionsThere are some achievements in CDM in CHCs:The GPs'duty system and good health education environment have been established; Follow-up enhance the relationship between the GPs and the patients; tangible headway was achieved by Consciousness of emphasizing prevention firstly and relevant departments of government cooperating each other; Foundation of laying stress on quality was well established; CDM in community realized five functions of integral wholesed. There are some problems:Relationship between CHCs and social medical insurance institution wasn't closely enough; We still lacked of methods and measures of CDM; Education of prevention and cure knowledge of chronic disease was not deeply and painstakingly; GPs'medical treatment technique and service attitude of visiting a patient at home should be improved; High medical expenses is still a problem to hypertension patients and diabetes patients in CHS.Policy Suggestions1. We should combine CHCs with social medical insurance institution closely to safeguard chronic patients'health right; 2. We should increase the methods and measures of CDM to increase the utilization level of CHS continuously and improve the control of chronic disease more effectively; 3. Self-management education should be developed to realize patients self manage their disease; 4. There were some persons who should be paid more attention to; 5. We should enhance training GPs to improve their technique level and their service attitude; 6. Government should invest more to CHCs to develop public hygiene service.Innovation1. It is the first time to study the statue of diabetes patients monitoring and treating disease in CHCs and its influencing factors. 2. We firstly evaluated the performance of the CDM management model, which combined management in grades with contractual management.