Research On The Current Situation,Demand And Countermeasures Of Conducting Health Management Of The Elderly Among Basic Public Health Services In Chongqing Urban Areas

To cope with the mounting pressure on health services brought by the severe trend of population aging,China launched the basic public health services in 2009,explicitly incorporating health management of the elderly into the content of this project,with the aim of moving the focus of chronic disease control in elderly population “forward”,basing ourselves on the “upstream” of elderly health maintenance,giving full play to the function of community health services so as to improve the health conditions of elderly population.Primary health facilities in Chongqing have been conducting health management of the elderly since 2009.However,there is no systematic evaluation of it to date.In order to further improve health management of the elderly,this research adopted several research methods(qualitative study and quantitative study in combination),objectively evaluated the current situation and existing problems of health management of the elderly under the framework of basic public health services of primary health facilities from the perspectives of both the supplier and the demander of health services,conducted systematic research on the demand of health management of the elderly from the perspectives of both the demander and the supplier,in the hope of providing scientific basis for the evidence-based decision-making of health management of the elderly in Chongqing.ObjectivesTo investigate the current situation and demand of health management of the elderly in Chongqing urban areas from the perspectives of both the supplier(primary health facilities)and the demander(the elderly population)through quantitative study and qualitative study in combination and put forward some countermeasures and suggestions accordingly.Methods1.Using the method of stratified random sampling randomly selected a representative district/county in chongqing urban areas,and then by extracting Primary Health Facilities of the district/county into community health service center of the city and rural townships hospitals,again from the community health service centers and townships hospitals into better development and poor,the last randomly selected two from each type of Primary Health Facilities(a total 8 Primary Health Facilities)as the research site.2.Quantitative study: selected 402 old people aged ? 60 who receive community health management in the 8 communities as the research subjects through complete random sampling method.Questionnaires were designed to investigate the general condition,dietary habits,lifestyles,disease status of health management of the elderly population in Chongqing and their awareness,utilization and assessment of health management services.The survey data were established into a database using Epidata3.1 and analyzed using SPSS17.0.Descriptive analysis of the demographic features,disease status,dietary habits and lifestyles of the respondents were conducted,and the awareness,utilization and satisfaction of the health management of the elderlyagement provided by primary health facilities among the elderly population were described using these indexes,including awareness rate,utilization rate and satisfaction rate.Related factors concerning the unhealthy dietary habits and lifestyles of the elderly population and their utilization and assessment of health management services were screened out through chi-square test,and were then analyzed through dichotomy logistic regression analysis.3.Qualitative study: 1)Focus group discussion(FGD): organized 2 groups(one male group and one female group)through snowball sampling method in each of the 8communities,i.e.16 groups in total,and mainly investigated their health conditions,health literacy,their awareness,utilization,assessment of community health management services,and the existing problems and their causes.2)In-depth individual interview: conducted in-depth individual interview with staff responsible for health management of the elderlyagement and chronic disease management,superintendent of public health and director of community health service centers(20 people in total)in the 8 community health service facilities through purpose sampling method,so as to investigate the service mode,service effectiveness,software and hardware conditions,service cost,existing problems andinfluencing factors of health management of the elderly.Processed and analyzed the qualitative materials collected in the study through thematic framework method which is widely adopted internationally.Results1.Current situation of conducting health management of the elderlyin primary health facilities in Chongqing urban areas1)The community health service facilities investigated have all provided health management of the elderlyagement services in accordance with the National Basic Public Health Service Specifications(2013 Edition).The services are provided to the elderly population aged ? 60 within the community,and cover these items,including lifestyles assessment,physical examination and auxiliary examination,health assessment and health guidance.The utilization rate of health management among the elderly population is higher than previous years and is about 70%-80% in most communities at present,and 50% in a few communities.Health service suppliers consider the current effectiveness of health management unsatisfactory.2)The awareness of health management service among the elderly population.The elderly population,on the whole,has a relatively high awareness of health record,physical examination and auxiliary examination and health guidance,and a relatively low awareness of health education.And they are aware through the following pathways: doctors to the community,notices from phone calls or short messages.3)The utilization situation of health management service among the elderly population.On the whole,the elderly population has a high utilization rate of health record,physical examination and auxiliary examination and health guidance.For a few of those who did not receive physical examination,the main reasons are as follows: first,consider it unnecessary;second,do not have time;third,not aware of;fourth,some family members of the elderly consider it unnecessary to receive physical examination.They have a relatively low utilization rate of health education.The reasons why the publicity materials and publicity columns were not utilized are as follows: first,poor eyesight and cannot see clearly;second,unable to read(illiteracy);third,poor memory and unwilling to spend time reading them.The reasons why health lectures were not utilized are as follows: first,not aware of;second,do not havetime;third,the relatively educated elderly are relatively aware of health knowledge and consider it unnecessary to attend such lectures.4)The satisfaction rate of health management service among the elderly population.The elderly population has a relatively high satisfaction rate of the items of health management services and a relatively high comprehensive assessment of the community health facilities providing such services.The highest satisfaction rates go to convenience(93.3%)and service attitude(92.8%);the relatively low satisfaction rates go to hardware conditions(62.3%),technical level(58.3%)and price(57.6%);the satisfaction rate assessment is associated with these factors,including age,literacy,occupation before retirement and gender.The reasons why the elderly were unsatisfied with the software and hardware conditions of the community health facilities are as follows: first,insufficient supply of drugs;second,poor equipment;third,technical level needs to be improved;fourth,some village health offices cannot give injection or transfusion.5)Existing problems and influencing factors of health management of the elderlyagement : first,the elderly lack health awareness;second,the items of health management of the elderlyagement lack appeal;third,insufficient manpower to carry out health management of the elderlyagement,lack of related professional training and shortage of material and financial support;fourth,in conducting health management of the elderlyagement,lack support form streets,neighborhood committees,city inspectors,proper manage systems and superior hospitals;fifth,indicators for performance appraisal are not scientific and reasonable.2.Demand assessment of conducting health management of the elderlyagement in Chongqing urban areas1)Disease status of the elderly.The proportion of the elderly getting any one type of chronic diseases is 81.7%,the proportion of getting at least two types of chronic diseases is48.8%,the proportion of getting at least 3 types of chronic diseases is 21.8%,while the proportion of not getting any disease is 12.7%.The morbidity rates ranging from high to low are: hypertension(61.9%),diabetes(28.4%),coronary heart disease(10.0%),dyslipidemia(8.7%),chronic bronchitis(8.0%)and osteoporosis(6.0%).2)The priority health problems that need to be solved among the elderly: first,add more personalized physical examination items;second,specific and targeted health guidance plan;third,technical level of primary health facilities needs to be improved,their equipment need to be updated and their drugs supply needs to be expanded;fourth,village health offices should be able to give treatment;fifth,the establishment of health record shall be combined with treatment.3)Most of the elderly have healthy dietary habits and lifestyles,while a small part of them have some bad dietary habits and lifestyles,such as frequently taking in fat meat,sweets,mainly consuming non-vegetarian food,eating relatively salty food,insufficient intake of fresh vegetables,eating too much for supper,lack of exercise,smoking,and alcohol drinking.Bad dietary habits and lifestyles are associated with the factors,including age,gender,registered residence,occupation before retirement,BMI index and whether having hypertension/diabetes or not.The elderly,on the whole,lack health knowledge and health awareness,and the discrepancy is quite obvious between the urban and rural areas.4)Health resources available for health management of the elderlyagement in primary health facilities.First,hope that primary health facilities can join hands with social security and medical security sectors and improve the utilization rate of health management of the elderlyagement by combining social security registration,medical security reimbursement,treatment of special diseases with the utilization of health management of the elderly;second,hope that they can carry out cooperation with their superior hospitals in sharing information resources of patients with hypertension/diabetes and providing technical support,so as to improve the efficiency of screening out the patients with chronic diseases and the elderly population's confidence in primary health facilities;third,hope that the local governments,streets,and neighborhood committees can take part in the publicity activities,so as to yield twice the result with half the effort in policy publicity.ConclusionsThe health management of the elderlyagement services provided by the primary health facilities in Chongqing urban areas have received the appraise and welcome of the elderly population on the whole and have helped to improve their health.However,the health management services provided at present are at their initial stage,and are far from the requirements of the national specifications and the real demand of the elderly population.The effectiveness of health management of the elderlyagement is low;the elderly population areunder great pressure of chronic diseases;their lifestyles and health literacy need to be improved.For primary health facilities to conduct health management of the elderlyagement,they are faced with the following difficulties: first,inadequate capacity of primary health facilities;second,insufficient awareness of health management of the elderlyagement of the society;third,the national input in this sector needs to be intensified;fourth,insufficient top-level design of health management of the elderlyagement;fifth,the multi-sectoral cooperation has not taken shape.According to the current situation and the demands of both the supplier and the demander of health management of the elderlyagement,the following countermeasures and suggestions are put forward:1.The government shall enhance its input of manpower,materials and finance into primary health facilities,strengthen the top-level design of health management of the elderlyagement,speed up the informatization of health management of the elderlyagement,and take the proactive and leading role in the multi-sectoral cooperation.2.The ability to provide health management of the elderlyagement should be enhanced by improving the management of primary health facilities and forging professional health management teams.3.The publicity work should be intensified so as to improve the society's awareness of health management of the elderlyagement;the health education modes should be innovated so as to improve the health literacy of the elderly population and help them establish the prevention-oriented health awareness.4.Sectors including social security,medical security,superior hospitals,streets,neighborhood committees and city management should establish the “pan-health conception”,and give full play to muli-sectoral cooperation and jointly improve the health management level.