摘要
背景我国农村地区高血压患病形势十分严峻,农村地区高血压健康管理工作尤为重要。目的基于世界卫生组织(WHO)提出的慢性病创新照护(ICCC)框架,总结山东省农村地区高血压健康管理的特点与存在的不足,并提出针对性建议。方法根据社会经济发展水平和山东省高血压患病率的地理分布,选取位于山东省菏泽市A县、济南市B区和威海市C市的3家县级疾控中心、9家乡镇卫生院、36个村卫生室作为样本来源地。采用目的抽样法,于2021年6—7月,选取各级高血压项目管理人员、医务人员及高血压患者共计84例为访谈对象,采用半结构式访谈法对其进行“面对面”访谈,了解山东省农村地区高血压健康管理现状。采用NVivo 12软件及由MILES和HUBERMAN提出的“综合法”,并围绕ICCC框架宏观、中观、微观3个层面的要素对访谈文本进行编码和分析。结果针对山东省农村地区高血压健康管理现状,从宏观、中观、微观3个层面共析出13个一级节点、51个二级节点。在宏观层面,山东省农村地区高血压健康管理总体处于积极的政策环境中,贯彻和落实国家慢性病健康管理相关政策,并对慢性病健康管理进行宣传,但是政策体系框架尚不完善、卫生系统内部的融合程度不佳、高血压健康管理专业人才紧缺、经费支持不到位等问题突出;在中观层面,各医疗卫生机构努力提升医疗服务的连续性,但是在组织和配备家庭医生团队、推广和使用信息系统等方面的工作还有待进一步加强;在微观层面,患者及家庭与家庭医生团队间的配合度,以及两方参与高血压健康管理的积极性还有待提高。结论山东省农村地区高血压健康管理工作整体运行情况良好,但仍须:大力发挥政府的领导和监督作用,制定并整合相关政策,推动部门融合;加大经费支持力度,补齐农村地区卫生人力资源相对匮乏和信息化建
Background As the prevalence of hypertension in China's rural areas is very high,hypertension management in these areas is particularly important.Objective To summarize the characteristics and weaknesses of hypertension management in Shandong's rural areas using the Innovative Care for Chronic Conditions Framework(ICCC)proposed by the WHO,and to put forward targeted recommendations.Methods According to the socio-economic level and geographical distribution of hypertension prevalence,three county-level centers for disease control and prevention,9 town health centers and 36 village clinics were selected from A county of Heze,B district of Jinan and C city of Weihai in Shandong Province,from which 84 cases(including individuals responsible for hypertension management programs,medical workers and hypertensive patients)were selected from June to July 2021 using a purposive sampling method to attend a face-to-face semi-structured interview for understanding the status of hypertension management in Shandong's rural areas.NVivo 12 and Qualitative Data Analysis Model proposed by MILES and HUBERMAN,were used to encode and analyse the interview results using the macro-,meso-and micro-level components of the ICCC.Results A total of 13 themes and 51 subthemes were derived from the analysis at three levels.At the macro level,the implementation of hypertension management in Shandong's rural areas was generally in a positive policy environment,such as implementing national policies regarding chronic disease management and publicizing chronic disease management,but the policy framework was not complete,the integration within the departments in the health system was poor,and shortages of professional hypertension managers and sufficient financial support were serious.At the meso level,various medical institutions strived to promote the continuity of medical services,but the organization and deployment of family doctor teams and the promotion and use of information systems still needed to be further strengthened.At the micro level,
作者
张硕
付英杰
常乐乐
孙晓杰
ZHANG Shuo;FU Yingjie;CHANG Lele;SUN Xiaojie(Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;NHC Key Lab of Health Economics and Policy Research(Shandong University),Jinan 250012,China)
出处
《中国全科医学》
CAS
北大核心
2023年第16期1972-1978,1983,共8页
Chinese General Practice
基金
山东省自然科学基金资助项目(ZR2019MG013)——社会资本对农村居家老年高血压患者生命质量的影响路径研究
山东大学青年交叉科学创新群体(2020QNQT019)——文旅康养产业交叉融合创新研究团队。
关键词
慢性病创新照护框架
农村
高血压
健康管理
质性研究
山东
Innovative Care for Chronic Conditions Framework
Rural
Hypertension
Health management
Qualitative research
Shandong
