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Objective Summarize domestic and international community health management models and characteristics for elderly hypertensive patients,providing references for the development of community health management in China.Methods Employ literature research to retrieve relevant documents on community health management models for elderly hypertensive pa-tients,and analyze the characteristics and applicability of different models through summarization and comparative analysis.Results In China,community health management models for elderly hypertensive patients include family doctor contracting serv-ices,Hospital-Community-Home health management model,traditional Chinese medicine health management model,"Internet+"health management model,PDCA cycle model,PRECEDE-PROCEED model,and comprehensive community management model.Foreign studies can be categorized into self-management model,Health Rise model,Community Health2(CH2)model,and community pharmacy management model.Conclusion Conducting hypertension health management for elderly patients at the community level is effective,serving as a widely applicable strategy for chronic disease prevention and control.Continued ex-ploration of the scientific and effective aspects of different management models,improving the efficiency and effectiveness of com-munity health management,can contribute more evidence for the formulation of scientific and effective strategies for chronic dis-ease prevention and control.
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The digital transformation of China's community health management is a key step in the high-quality development of medical and health services,and is of great significance in enhancing the health and well-being of all residents.Using literature analysis,logical analysis and other research methods,it analyzes the practical foundation and constraints of the digital transformation of China's community health management,and proposes optimization strategies.It concludes that national policy,infrastructure development and social demand provide a realistic foundation for the digital transformation of community health management in China,but it also faces the problems of insufficient transformation of thinking,the concept of digital management has not sufficiently replaced the traditional concepts;the technical foundation is weak,and the construction and operation of the digital application platform started late;the structural barriers are prominent,and the lack of sound system construction leads to insufficient cooperation among the main bodies;the lack of digital standards,and the lagging operation of digital standardization of community health management;and the lack of digital standards.Management digital standardized operation lagging behind the constraints.Accordingly,it is proposed to promote the identity of the digital transformation of community health management,to build an operational space for digital community health management,to improve the digital system to regulate the activation of synergistic governance of the main body,and to optimize the supervision and guarantee of technology in digital management.
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Objective@#To investigate the acceptance status of internet+health management among hypertensive patients in Xuzhou city and the related influencing factors.@*Methods@#An interviewing questionnaire survey on the acceptance of internet+health management was conducted among 1,200 hypertensive patients from Xuzhou community health service centers selected by randomized cluster sampling and stratified sampling methods from February tp August 2018, 1 116 valid questionnaires were finally obtained with a response rate of 93.0%. The respondents were divided into two groups according to whether they would accept the internet+health management, and the general conditions and health management status of the two groups were compared.@*Results@#The acceptance rate of internet+health management was 71.9% (802/1 116). The univariate analysis showed that age, education level, occupation, and monthly income of hypertensive patients were associated with the acceptance of internet+health management (P<0.05); patients with family history of hypertension, cardiovascular and cerebrovascular complications and high health literacy had higher acceptance rate of internet+health management (P<0.05). Multivariate analysis showed that educational levels of junior high school and above (OR=0.426, 0.318, 0.089), good sleep (OR=0.453) were protective factors for acceptance of internet+health management; while not knowing the diagnostic criteria for hypertension (OR=1.494), not knowing the blood pressure monitoring (OR=2.668), not knowing ECG monitoring (OR=2.247), quitting smoking (OR=2.444), no complications (OR=2.247), and not participating in community health management (OR=1.758) were the risk factors of acceptance of internet+health management for patients with hypertension.@*Conclusion@#The acceptance rate of internet+health management among hypertensive patients in Xuzhou city is relatively high. A variety of factors have impact on the acceptance of internet + health management.
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Objective@#To analysis of the effect of strengthening management of dyslipidemia in community based on family doctor contracting service.@*Methods@#In December 2014, 1267 cases patients with dyslipidemia aged over 18 years were selected from three community health service centers in Hangzhou, including 645 in intervention group (311 males and 334 females) and 622 in control group (307 males and 315 females). In the intervention group, the management of dyslipidemia in community was strengthened by graded follow-up and personalized diagnosis and treatment based on the contracted services of family doctors, while the control group adopted the general management of dyslipidemia in the community. After 12 months of intervention, the changes of lifestyle (smoking, drinking, body mass index, waist circumference), regularly taking lipid-regulating drugs, blood lipid, blood pressure, blood sugar levels and their control rates were compared by χ2 test or t test before and after intervention between the intervention group and the control group. Non-conditional logistic regression analysis was used to analyze the influencing factors of blood lipid attainment.@*Results@#Before intervention, there were no significant differences in gender, age, cardiovascular risk stratification, the levels of lipid and other metabolic indicators, lipid compliance rate between intervention group and control group (P> 0.05). After intervention, the intervention group improved in drinking, overweight,obesity, abdominal obesity, and the rate of regularly taking lipid-regulating drugs increased,compared with the control group, the difference was statistically significant (χ2=5.923,4.765,8.587,5.341, 5.654; all P<0.05). The levels of total cholesterol, triglyceride, low density lipoprotein cholesterol, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobinin the intervention group were lower than those in the control group, the differences were statistically significant (t=-4.987,-3.207, -6.280, -3.339, -2.466, -4.052, -5.012, -2.865, -2.450; all P<0.05), while the HDL-C level in the intervention group was higher than that in the control group (t=2.294; P<0.05). The control rate of blood lipids, the control rate of blood pressure, and the combined control rates of blood lipid, blood pressure and blood sugar in the intervention group were higher than those in the control group, the differences were all significant (χ2=31.262,4.818,17.245; all P<0.05). Unconditional logistic regression analysis showed that family doctor contracted services (OR=1.961, 95%CI: 1.485-2.589), gender (OR=0.662, 95%CI: 0.471-0.930), smoking (OR=0.498, 95%CI: 0.332-0.745), obesity (OR=0.570, 95%CI: 0.359-0.904), hypertension (OR=0.353, 95%CI: 0.259-0.480), diabetes mellitus (OR=0.340, 95%CI: 0.239-0.483) was the influencing factor of blood lipid reaching the target (all P<0.05).@*Conclusion@#Intensive management of dyslipidemia in community based on family doctor's contracting service is helpful to improve the management effect of dyslipidemia.
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Objective To investigate the acceptance status of intemet + health management among hypertensive patients in Xuzhou city and the related influencing factors.Methods An interviewing questionnaire survey on the acceptance of internet + health management was conducted among 1,200 hypertensive patients from Xuzhou community health service centers selected by randomized cluster sampling and stratified sampling methods from February tp August 2018,1 116 valid questionnaires were finally obtained with a response rate of 93.0％.The respondents were divided into two groups according to whether they would accept the internet + health management,and the general conditions and health management status of the two groups were compared.Results The acceptance rate of internet + health management was 71.9％ (802/1 116).The univariate analysis showed that age,education level,occupation,and monthly income of hypertensive patients were associated with the acceptance of internet + health management (P＜0.05);patients with family history of hypertension,cardiovascular and cerebrovascular complications and high health literacy had higher acceptance rate of internet+health management (P＜0.05).Multivariate analysis showed that educational levels of junior high school and above (OR=0.426,0.318,0.089),good sleep (OR=0.453) were protective factors for acceptance of internet+health management;while not knowing the diagnostic criteria for hypertension (OR=1.494),not knowing the blood pressure monitoring (OR=2.668),not knowing ECG monitoring (OR=2.247),quitting smoking (OR=2.444),no complications (OR=2.247),and not participating in community health management (OR=1.758) were the risk factors of acceptance of internet + health management for patients with hypertension.Conclusion The acceptance rate of internet+health management among hypertensive patients in Xuzhou city is relatively high.A variety of factors have impact on the acceptance of internet + health management.
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Objective@#To evaluate the cost-effectiveness of intervention and management of the patients with dyslipidemia in some districts in Shenzhen and provide health economic basis for prevention and control of dyslipidemia.@*Methods@#We conducted a comprehensive community intervention among patients for dyslipidemia management, enrolling 204 cases of dyslipidemia in the intervention group and 200 cases in the control group through multi-stage cluster random sampling. We collected baseline and intervention data, such as the cost of institutional intervention (labor costs, office expenses, material expenses, loss of low-value consumables, service costs, and depreciation of fixed assets), patient costs (direct and indirect medical costs), effect indicators (lipid control rate, lipid improvement rate, and lipid exacerbation rate) to analyze cost-effectiveness.@*Results@#After 12 months of the comprehensive community intervention, the total cost for the intervention group was 1 321.62 yuan per capita; the cost per patient was 973.33 yuan; and per capita institutional cost was 348.29 yuan. Total cholesterol, triglyceide, and high-density lipoprotein cholesterol of intervention group decreased by 0.43 mmol/L, 0.16 mmol/L, and 0.42 mmol/L, respectively, after the intervention, and there was a significant difference before and after the intervention (P<0.05). After intervention, the intervention group lipid control rate was 17.6%, the lipid improvement rate was 48.0%, and the lipid exacerbation rate was 7.4%, whereas those of the control group were 10.5%, 22.5%, and 16.0%, respectively. The lipid control rate and improvement rate in the intervention group were higher than those in the control group, and the lipid exacerbation rate was lower than that of the control group. The difference between the two groups was statistically significant (χ2=43.774, P<0.001). Patients in the control group had a unit cost of 81.17 yuan for 1% of blood lipid control rate and 37.88 yuan for one unit of blood lipid improvement rate. The corresponding per capita cost of the intervention group was 74.87 yuan and 27.51 yuan, respectively. The intervention group's cost-effect ratio was lower than that of the control group and had good cost-effectiveness.@*Conclusions@#The comprehensive community intervention and management of patients with dyslipidemia was effective in terms of health economics and it is worth the long-term implementation and promotion in the community health service center.
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Under the guidance of State Administration of Traditional Chinese Medicine, Shanghai Municipal Commission of Health and Family Planning and Shanghai Municipal Office for Development of Traditional Chinese Medicine, Traditional Chinese Medicine( TCM) preventive health care service system was started to construct in 2011 in Changning District of Shanghai.The system was residents'needs orien-ted.After five years of effort, TCM preventive health care service system characterized with integration of prevention and treatment, multicultural atmosphere, supported by TCM featured services was formed.The new model of community health management provided a positive and beneficial practice for the Healthy City construction with Chinese and Shanghai characteristics.