Study On The Situation Of Health Management Of Non-communicable Chronic Diseases(HM-NCDs),the Capacity Of Healthcare Workers To Delivery HM-NCDs And Measures To Improve It In Primary Healthcare Sections In Chongqing

With the development of society,the burden of NCDs in China is increasing,which not only poses a great threat to residents? health,but also places a heavy economic burden on families and the country.China launched a national basic public health service program which covers the health management of Non-communicable Chronic Diseases(hypertension and diabetes)since 2009.Chongqing attaches great importance to the implementation of basic public health programs and invests a lot.Chronic health management in the basic public health programs comprises of three services of disease screening,follow-up evaluation and classified intervention,and health examination,provided free of charge by primary medical institutions to NCDs patients(hypertension patients and diabetes patients)within the jurisdiction.The purpose of this paper is to make a comprehensive and systematic study on the implementation of chronic health management in basic public health services of primary medical institutions in Chongqing,so as to provide scientific proof for further improvement of chronic disease health management level.Objective: By taking the mixed means of quantitative(questionnaire survey)and qualitative(focus group discussion and key person interview)research methods from two different perspectives of health management medical service demanders(chronic disease patients)and suppliers(primary medical institutions),this paper aims to evaluate the implementation and challenges of chronic disease health management program in Chongqing primary medical institutions,so as to provide scientific proof for further improvement of chronic disease health management level.Methods: The research selects Shapingba Chongqing purposely as the research site to study the current situation of chronic disease health management in primary medical institutions;selects 24 districts and counties of Chongqing as the research site by stratified sampling to evaluate the ability of chronic disease health managers in primary medical institutions.1)NCDs patients from the institutions were investigated with questionnaires to understand those chronic disease patients,as well as their knowledge,utilization and satisfaction of chronic disease health management.Questionnaire survey was conducted among staff engaged in NCDs management in primary medical institutions to get a knowledge of the general situation of chronic disease management personnel,self-assessment of chronic disease health management ability,training,job satisfaction and impacts.2)Focus group discussion: Objective sampling method was used to study NCDs patients’ awareness,utilization and evaluation of chronic disease health management services,as well as existing problems and causes,etc.in those medical institutions.3)Key person interview: In 8 selected communities,the persons in charge of primary medical institutions and public health service personals were selected with a purpose to conduct key person interviews to understand the relevant policies of basic public health services in Chongqing,the main public health service needs of community residents,the development of community public health services and influencing factors.Results:1.Non-communicable chronic disease health management in primary medical institutions in Shapingba district,ChongqingOverall,NCDs patients? awareness,utilization and satisfaction level is fairly good,especially the overall awareness,utilization and overall satisfaction of three health management programs(the screening,follow-up assessment and classification of intervention of chronic disease,health examination)of high blood pressure,diabetes reaches up to over 93%.However,the awareness and utilization rate are 58.5% and 62.4% respectively which are comparatively low in the aspects of institutions providing health education lecture and other health education projects.1)Factors related to NCDs patients’ awareness of chronic disease management: the location of household is related to hypertension patients’ awareness of health education services(P < 0.05),and the awareness rate of rural households is lower than that of urban household.Health service quality is an influencing factor of NCDs patients’ health education service items(P < 0.05),and the awareness rate of those with poor service quality was lower.Some patients in rural medical institutions stated they were unknown about the chronic disease health management project,only heard about blood pressure and blood sugar measurement.2)The main reasons for the insufficient utilization of NCDs patients’ health management: first,the health consciousness is low,and the importance of health guidance is ignored.Second,the lifestyle is difficult to change.Patients cannot follow doctor’s health guidance.Third,patients lack trust towards primary medical institutions;Fourth,patients have no time to take follow-up visits.Fifth,the health propaganda is ineffective.3)Most NCDs patients are satisfied with health management service.The main dissatisfaction of hypertension patients was from physical examination(93.6%)and health guidance(82.3%).The major reasons for their dissatisfaction are as follows: first,the drugs in the primary medical institutions are not complete and the equipment there is backward.Second,there are only few physical examination items and those items are not special enough.Third,the available health service items are limited which cannot meet patients ?actual health needs.Fourth,patients doubt about the health guidance contents.Fifth,the pertinence of the content of health guidance is not strong.2.Current situation of chronic disease health management capacity construction in primary medical institutionsMost of the chronic diseases? administrative personals in primary medical institutions are young people.In more details,40.3% of them are under 30 years old,and 42.1% of them have less than three working years.85.7% of the staff shoulder the responsibilities from more than three posts.61.6% of them have college degrees,92.7% have received medical college education,40.5% major in nursing,and 72.4% have primary professional titles.In terms of job competence,the awareness rate of chronic disease administrative personals in primary medical institutions about the chronic disease health management programs they undertake is as high as over 99%.In the aspects of job competence,the overall situation is relatively good.The competency rate of three health management services(the screening,follow-up assessment and classification of intervention of chronic disease)of high blood pressure,diabetes exceeds 95%.The poor competent behaviors mainly lie on the aspects of health education and five health education projects(including providing health education materials,setting up health education publicity columns,launching the public health consultancy services,holding health lectures,and offering personalized health education programs)with a low competency rate of below 86%.Both of competency rate of holding health lectures and offering personalized health education programs is less than 80%.The main causes of incompetence are their lack of relevant knowledge,or both lack knowledge and skills.The categories of primary medical institutions,administrative personals? educational level,medical education,and the number of posts they held are influential factors for the competency of several health education programs.Speaking of the training,87.2% of chronic disease administrative personals in primary medical institutions have received training in the past half year.The top three desired training programs are about professional knowledge(17.7%),professional skills(16.7%)and basic public hygienic practice(15.9%).The most desirable form of training is field instruction(32.0%).The most desirable training frequency is twice every half a year(31.1%).In terms of job satisfaction,57.8% of workers are satisfied with their jobs,and more than half of respondents believe that income increase can improve job satisfaction.Conclusion:The overall health management of NCDs patients in primary medical institutions in Shapingba district,Chongqing is fairly good,with a high awareness and utilization rate and satisfaction level.However,on one hand,there are still some problems such as unbalanced health management services for NCDs patients and differences in the utilization of capacity among different groups.On the other hand,the chronic disease health management service capacity in primary medical institutions in Chongqing still needs to be improved.Currently,there are problems such as insufficient number of personals,low level of professional knowledge and skills,insufficient research of public health,and weak integration of medical treatment and prevention.The health management of chronic diseases in primary medical institutions is also faced with the following challenges: first,the number of chronic patients is large.Second,the health literacy of NCDs patients needs to be improved.Third,the superior departments pay insufficient attention to the practical difficulties in the implementation of chronic disease health management.Fourth,the application of modern means in the process of service development is not enough.Based on the current situation of chronic disease health management and the capacity construction of primary medical institutions,the following countermeasures and suggestions are put forward.1.At the government level: first,a favorable supportive environment for chronic disease health management should be created by providing a strong guarantee for chronic disease health management in the perspectives of policy formulation,financial input,public opinion guidance and other aspects.Second,the service capacity in primary medical institutions should be advanced by increasing their staffing,raising their salaries and benefits,and strengthening their drug supply.Third,the top-level design of chronic disease health management should be reinforced by dynamically adjusting the contents of chronic disease health management programs as needed,optimizing the performance evaluation index system to form an incentive mechanism for chronic disease management,promoting interdisciplinary research,and exploring a new model of chronic disease health management based on new technologies.2.At the level of primary medical institutions: first,the concept of chronic disease health management must be further deepened,to make it clear that chronic disease health management is not equal to the management of chronic disease patients,and vigorously promote the development of health promotion and health education activities within the jurisdiction.Second,the allocation of human resources and shoud be optimized and strengthen the talent team construction must be strengthened.Third,a reasonable salary incentive distribution mechanism to further stimulate the enthusiasm of chronic disease management staff should be established.Fourth,a new training model could be promoted to improve the training quality.Fifth,personalized health services should be carried out to enhance the attractiveness of service programs.3.In chronic disease patients level: first,patients should consciously improve health awareness and enhance self-health promotion ability.Second,they should actively participate in chronic disease health management,turn passive management to active prevention and treatment,so that both doctors and patients could work together to improve health level.