基于收益人群狭窄的慢性病防控服务均等化严重障碍研究  

Narrow Coverage:The Obstacle of Service Equality of Chronic Disease Prevention and Control

作　　者：汤淑女[1] 方任飞[1] 谢铮[1] 简伟研[1] 

机构地区：[1]北京大学公共卫生学院,北京市100191

出　　处：《中国全科医学》2013年第34期4034-4036,共3页Chinese General Practice

基　　金：国家自然科学基金面上(青年)项目(71003002)

摘　　要：目的了解被调查地区慢性病管理的实际情况,发现阻碍慢性病防控服务均等化的严重障碍。方法 2012年10—12月收集某东部城市地区社区卫生服务机构慢性病管理的相关资料,计算该地区高血压和糖尿病的实际发现率和实际管理率;并对该地区接受社区卫生服务的常住居民进行抽样调查,分析不同地区类型和不同收入人群接受慢性病管理服务的差异。结果 (1)2009—2011年,被调查地区发现的高血压和糖尿病患者数量虽然有所提升,但与这两种病的理论患病人数相比,发现的患病人数所占比例一直较低(2011年,高血压和糖尿病的实际发现率分别为22.7%和32.6%),实际管理人数所占比例更低(2011年,高血压和糖尿病实际管理率分别为1.7%和3.6%)。(2)不同社区类型(城乡结合部和城市社区)居民接受慢性病管理间差异无统计学意义(χ2=0.048,P=0.827);但收入越高,接受慢性病管理的比例越低,差异有统计学意义(χ2=33.223,P<0.001)。结论收入依然是影响慢性病管理服务可获得性的重要因素。而且,慢性病管理收益面狭窄,将许多慢性病患者排除在慢性病管理服务以外,是慢性病防控服务均等化的严重障碍。Objective To study the status of chronic disease management in investigated area, and to find the factors impeding the service equalization of chronic disease prevention and control. Methods Relevant information of chronic disease management in community health service institutions in an east city of China was collected from October to December in 2012. The actual discovery rate and actual management rate of hypertension and diabetes were calculated. Data of the permanent residents of the city who received the community health service was collected to analysis the difference of chronic disease management among communities and different income groups. Results The numbers of registered hypertension and diabetes in the investigated area increased from 2009 to 2011 ; but the discovery rates were very low, the discovery rates of hypertension and diabetes were 22. 7% and 32. 6% respectively in 2011. Thc actual management rate were also lower, and the actual management rate of hypertension and diabetes were 1.7% and 3.6%, respectively in 2011. There was no significant difference in receiving chronic disease man- agement between the urban - rural integration areas and urban areas （ X2 =0. 048, P = 0. 827 ）, but the proportion of receiving chronic disease management was significantly lower in the higher income group than in the lower income group （ X2 = 33. 223, P 〈0. 001 ） . Conclusion Income is still an important factor affecting the accessibility of chronic disease management services. Moreover, narrow coverage of chronic disease management, excluding many patients with chronic disease from the chronic disease management services, is a serious obstacle to achieve service equality of chronic disease prevention and control.

关 键 词：基本公共卫生服务 均等化 慢性病 管理 障碍 

分 类 号：R197[医药卫生—卫生事业管理]