CAJ | 학술논문

目的：了解我国慢性非传染性疾病（慢性病）预防控制政策能力，各级疾病预防控制中心（CDC）和基层医疗卫生机构慢性病预防控制能力现状。方法通过网络问卷调查全国省、地（市）和县（区）级3352家CDC及1200家基层医疗卫生机构。结果（1）政策能力：省、地（市）和县（区）级政府配置慢性病预防控制专项经费的比例为75.0%、19.7%和11.3%。（2）基础配置能力：7.1%的县（区）级CDC设有慢性病预防控制科（所）。2009年各级CDC有8263人从事慢性病预防控制工作，占CDC总在岗人员的4.2%。全国CDC有40.2%配置了慢性病预防控制专项经费。（3）培训指导能力：省级CDC举办慢性病预防控制培训班的比例（96.9%）高于地（市）（50.3%）和县（区）级（42.1%）。48.3%县（区）级CDC对基层医疗卫生机构开展过指导。（4）合作与参与能力：CDC与媒体开展合作的比例较高，为20.2%。（5）监测能力：县（区）级CDC开展死因监测的比例为64.6%；开展各类慢性病及危险因素监测的比例均不到30%。基层医疗卫生机构开展新发脑卒中和急性心肌梗死病例报告的比例分别为18.6%和3.0%。（6）干预与管理能力：CDC开展高血压和糖尿病患者个体化干预的比例分别为36.1%和32.2%，开展其他各类慢性病及危险因素干预的比例均不到20%。超过50%的基层医疗卫生机构开展高血压或糖尿病患者随访管理工作，但高血压和糖尿病患者管理率分别仅为12.0%和7.9%，规范管理率分别为73.8%和80.1%，控制率分别为48.7%和50.0%。（7）评估能力：13.3%的CDC或卫生行政部门对本辖区慢性病应对情况开展定期评估。（8）科研能力：省级CDC科研能力明显高于地（市）和县（区）级。结论各地慢性病预防控制政策能力偏低；县（区）级CDC慢性病预防控制能力与省和地（市）级有较大差距，亟待提高；基层医疗卫生机构开展慢性病预防控制相关工作的效果不佳。目的：瞭解我國慢性非傳染性疾病（慢性病）預防控製政策能力，各級疾病預防控製中心（CDC）和基層醫療衛生機構慢性病預防控製能力現狀。方法通過網絡問捲調查全國省、地（市）和縣（區）級3352傢CDC及1200傢基層醫療衛生機構。結果（1）政策能力：省、地（市）和縣（區）級政府配置慢性病預防控製專項經費的比例為75.0%、19.7%和11.3%。（2）基礎配置能力：7.1%的縣（區）級CDC設有慢性病預防控製科（所）。2009年各級CDC有8263人從事慢性病預防控製工作，佔CDC總在崗人員的4.2%。全國CDC有40.2%配置瞭慢性病預防控製專項經費。（3）培訓指導能力：省級CDC舉辦慢性病預防控製培訓班的比例（96.9%）高于地（市）（50.3%）和縣（區）級（42.1%）。48.3%縣（區）級CDC對基層醫療衛生機構開展過指導。（4）閤作與參與能力：CDC與媒體開展閤作的比例較高，為20.2%。（5）鑑測能力：縣（區）級CDC開展死因鑑測的比例為64.6%；開展各類慢性病及危險因素鑑測的比例均不到30%。基層醫療衛生機構開展新髮腦卒中和急性心肌梗死病例報告的比例分彆為18.6%和3.0%。（6）榦預與管理能力：CDC開展高血壓和糖尿病患者箇體化榦預的比例分彆為36.1%和32.2%，開展其他各類慢性病及危險因素榦預的比例均不到20%。超過50%的基層醫療衛生機構開展高血壓或糖尿病患者隨訪管理工作，但高血壓和糖尿病患者管理率分彆僅為12.0%和7.9%，規範管理率分彆為73.8%和80.1%，控製率分彆為48.7%和50.0%。（7）評估能力：13.3%的CDC或衛生行政部門對本轄區慢性病應對情況開展定期評估。（8）科研能力：省級CDC科研能力明顯高于地（市）和縣（區）級。結論各地慢性病預防控製政策能力偏低；縣（區）級CDC慢性病預防控製能力與省和地（市）級有較大差距，亟待提高；基層醫療衛生機構開展慢性病預防控製相關工作的效果不佳。
목적：료해아국만성비전염성질병（만성병）예방공제정책능력，각급질병예방공제중심（CDC）화기층의료위생궤구만성병예방공제능력현상。방법통과망락문권조사전국성、지（시）화현（구）급3352가CDC급1200가기층의료위생궤구。결과（1）정책능력：성、지（시）화현（구）급정부배치만성병예방공제전항경비적비례위75.0%、19.7%화11.3%。（2）기출배치능력：7.1%적현（구）급CDC설유만성병예방공제과（소）。2009년각급CDC유8263인종사만성병예방공제공작，점CDC총재강인원적4.2%。전국CDC유40.2%배치료만성병예방공제전항경비。（3）배훈지도능력：성급CDC거판만성병예방공제배훈반적비례（96.9%）고우지（시）（50.3%）화현（구）급（42.1%）。48.3%현（구）급CDC대기층의료위생궤구개전과지도。（4）합작여삼여능력：CDC여매체개전합작적비례교고，위20.2%。（5）감측능력：현（구）급CDC개전사인감측적비례위64.6%；개전각류만성병급위험인소감측적비례균불도30%。기층의료위생궤구개전신발뇌졸중화급성심기경사병례보고적비례분별위18.6%화3.0%。（6）간예여관리능력：CDC개전고혈압화당뇨병환자개체화간예적비례분별위36.1%화32.2%，개전기타각류만성병급위험인소간예적비례균불도20%。초과50%적기층의료위생궤구개전고혈압혹당뇨병환자수방관리공작，단고혈압화당뇨병환자관리솔분별부위12.0%화7.9%，규범관리솔분별위73.8%화80.1%，공제솔분별위48.7%화50.0%。（7）평고능력：13.3%적CDC혹위생행정부문대본할구만성병응대정황개전정기평고。（8）과연능력：성급CDC과연능력명현고우지（시）화현（구）급。결론각지만성병예방공제정책능력편저；현（구）급CDC만성병예방공제능력여성화지（시）급유교대차거，극대제고；기층의료위생궤구개전만성병예방공제상관공작적효과불가。
Objective To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention(CDCs)at all levels and grass roots health care institutions,in China. Methods On-line questionnaire survey was adopted by 3 352 CDCs at provincial,city and county levels and 1 200 grass roots health care institutions. Results 1)On policies:75.0% of the provincial governments provided special fundings for chronic disease prevention and control,whereas 19.7%city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control,accounting for 4.2% of all the CDCs’personnel. 40.2% CDCs had special fundings used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs,96.9%at provincial level,50.3%at city level and 42.1%at county level had organized trainings on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation:20.2%of the CDCs had experience in collaborating with mass media. 5)Surveillance capacity:64.6% of the CDCs at county level implemented death registration,compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions,18.6% implemented new stroke case reporting system but only 3.0%implemented program on myocardial infarction case reporting. 6)Intervention and management capacity:36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes,while less than another 20%intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9%,with rates on standard management as 73.8%and 80.1%and on control as 48.7%and 50.0%,respectively. 7) Capacity on Assessment:13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8)On scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs. Conclusion Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions,both prevention and control programs on chronic diseases did not seem to be effective.