| ObjectiveThe research and prevention of chronic diseases is a popular topic in the innovation of modern medicine and the reform of medical and health service.For the etiology and risk factors of chronic diseases,the prevention and control strategy should not only pay attention to the influence of etiology,but also actively intervene in health risk factors,such as controlling tobacco,drinking,exercise and dietary habits,etc.And we should concern about environmental development,policy change and improving the quality of health services.In this study,a cross-sectional study is intended to examine the prevalence of multimorbidity or multiple chronic condition among the people in a district of Shenzhen city,and the health status of the patients,the unhealthy behaviors,the disease treatment burden and the utilization of community health resources.We used a Primary Care Assessment Tool(PCAT)to assess the effectiveness of multimorbidity patient health management in the community.The study hopes to improve the quality of community health services and the prevention and treatment of chronic diseases.MethodsFrom May to November 2017,33 community health centers were selected from eight districts under the jurisdiction of a district central hospital in Shenzhen city.With simple random sampling,at least 15%of the patients with chronic diseases were randomly selected from 33 community health centers’case records.A total of 6105valid questionnaires were completed.The questionnaire is designed on the basis of literature review,including social demographic characteristic,health examination indicators,disease diagnosis,unhealthy behaviors,utilization of community medical services,Treatment Burden Questionnaire and PCAT scale.Data was entered with EpiData 3.1 version.SPSS 16.0 software was used for statistical processing and analysis.Results1.The radios of multimorbidity in the community was as follows:there were 52.19%cases with one type of chronic diseases,33.94%with 2 types,10.97%cases with 3types,and 2.90%cases with 4 or above.The top 10 most prevalent chronic diseases were hypertension,diabetes,dyslipidemia,chronic pain,bone and connective tissue inflammation,heart disease,gallbladder and spleen disease,hyperuricemia,peripheral vascular disease and stroke.The radio of multimorbidity in patients with chronic diseases was 47.81%.The rate of multimorbidity in females was higher than that in males(49.54%V.S.46.30%),and the difference was statistically significant(χ~2=6.405,P=0.011).There are differences in the rate of multimorbidity in different age groups(χ~2=73.699,P<0.001).With the increase of age,the rate of multimorbidity tended to increase,with the age group of 65 or above having the highest(56.63%).There are differences in the rates of multimorbidity with different household registration types(χ~2=38.700,P<0.001),with the local group having the highest(58.52%).There are differences in the rates of multimorbidity with different educational backgrounds(χ~2=22.502,P<0.001),with the junior education group having the highest(52.33%).The rate of multimorbidity with medical insurance was higher than that of non-insured patients(49.43%V.S.46.06%),and the difference was statistically significant(χ~2=6.938,P=0.008).There was significant difference in the rate of multimorbidity among different household income(χ~2=33.514,P<0.001),with the group whose monthly income is more than 9001 yuan group having the highest(89.20%).2.The obesity rate in patients with chronic diseases was 13.02%.The rate of obesity in multimorbidity was higher than that in patients with single chronic diseases(14.29%V.S.11.86%),and the difference was statistically significant(χ~2=7.885,P=0.005).Among female,the rate of obesity in multimorbidity was higher than that in patients with single chronic diseases(14.29%V.S.11.86%),and the difference was statistically significant(χ~2=5.476,P=0.019).The abnormal rate of blood pressure detection,blood glucose detection,total cholesterol and triglyceride in multimorbidity were higher(P<0.05).3.The smoking rate of chronic patients was 13.46%.The smoking rate of multimorbidity was lower than that of patients with single chronic diseases(12.47%V.S.14.38%),and the difference was statistically significant(χ~2=4.746,P=0.029).The drinking rate in patients with chronic diseases was 16.51%.The drinking rate of multimorbidity was higher than that of patients with single chronic diseases(17.57%V.S.15.54%),and the difference was statistically significant(χ~2=4.589,P=0.032).The lack of exercise rate of chronic patients was 36.43%.The lack of exercise rate of multimorbidity was lower than that of patients with single chronic diseases(33.92%V.S.38.73%),and the difference was statistically significant(χ~2=15.258,P<0.001).4.The score of treatment burden for chronic patients was 14.14±12.937.The treatment burden of chronic patients was 75.35%in the low burden grade,followed by the moderate burden grade(22.85%).The treatment burden of multimorbidity was higher than that of patients with single chronic diseases(H=5.370,P<0.001).5.The signing rate of family doctors for patients with chronic diseases in the region was 78.61%.There is no difference in the signing rate of family doctors between the multimorbidity and the single chronic disease in this area(χ~2=3.618,P=0.057).The average of contracting time for chronic patients with signed family doctors was 8.69months.The average of contracting time for multimorbidity with signed family doctors was 8.84 months,while that for single chronic patients was 8.55 months.There was no difference between the two groups(t=0.877,P=0.381).28.65%of the patients with chronic diseases signed for more than one year,while 59.18%patients signed for less than half a year.The average number of services was 5.10 for chronic patients.The average number of services was 5.25 for multimorbidity group and 4.96for single chronic disease patients.There was no difference between the two groups(t=0.196,P=0.232).64.29%of the patients with chronic diseases had four or more times of services,while 4.58%of the patients had not received contract services from family doctors in the past year.The rate of health examination in the chronic disease patients last year was 72.33%.The rate of health examination in the group with multimorbidity in the past year was higher than that in the group of single chronic diseases(74.58%V.S.70.28%),and the difference was statistically significant(χ~2=14.102,P<0.001).The rate ofparticipating in health education organization activity in the chronic disease patients last year was 77.04%.The rate of participating in health education organization activity in the group of multimorbidity in the past year was lower than that in the group of single chronic diseases(75.20%V.S.78.72%),and the difference was statistically significant(χ~2=10.684,P=0.001).6.The PCAT score of the patients with chronic patients was 85.49±19.264,and the whole score was at the middle grade.The PCAT score of the patients with multimorbidity was 85.07±19.708,and the whole score was at the middle grade.35.73%of the people with multimorbidity had high grade and 11.96%of them were assessed as low grade.On the two dimensions of"service continuity"and"service comprehensiveness",the proportion was high(52.66%to 58.68%).On the two dimensions of"service use","family oriented and community-oriented",the proportion of evaluation in high grade was less(31.07%~32.61%).Compared with single chronic disease group,the scores of"service use","family oriented and community-oriented"were lower in multimorbidity group,and the difference was statistically significant(P<0.05).There was no statistical difference between the two groups in other dimension scores(P>0.05).The regression analysis indicated that different household registration types,education level,medical insurance status,per monthly income of families,treatment burden classification,family service and numbers of chronic diseases were affected the evaluation grade in patients with multimorbidity.Conclusions1.The radio of multimorbidity in the chronic disease patients was 47.81%.Hypertension,diabetes,dyslipidemia,chronic pain,inflammation of bone and connective tissue,heart disease were prevalent..2.The problems of obesity,blood pressure,biochemical examination existed and the unhealthy behaviors such as smoking and drinking in the community with chronic diseases.3.The evaluation of community health services by patients with chronic diseases was not high.Most of them agree that social health service is long-term sustainable and comprehensive service was better.The main problem is that the first contact to community health service was poor. |
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