中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2013年
4期
301-305
,共5页
李建新%梁小华%曹杰%朱坤%邓颖%周正元%王仪%万国生%赵川
李建新%樑小華%曹傑%硃坤%鄧穎%週正元%王儀%萬國生%趙川
리건신%량소화%조걸%주곤%산영%주정원%왕의%만국생%조천
高血压%城市%医疗保险%农村%就诊机构
高血壓%城市%醫療保險%農村%就診機構
고혈압%성시%의료보험%농촌%취진궤구
Hypertension%Cities%Medicare%Rural%Clinical agency
目的 通过对2010年中国5个省城乡社区高血压患者就诊机构、就医现况和医疗保障的比较,旨在为国家基本公共卫生服务项目高血压患者健康管理的实施和效果评估提供基础性数据.方法 于2010年,在我国江苏、山东、河北、四川和甘肃5个省,主要根据经济发展水平,依次抽取市、区县,最终确定10个调查点.采用整群抽样方法,在每个调查点抽取3～4个社区或乡镇,调查符合标准的社区高血压患者8326例,其中城市4363例,农村3963例,针对城乡高血压患者的就诊机构、就医现况和医疗保障情况进行比较.结果 城市社区高血压患者首次诊断机构主要为区(县)级及以上医院(43.74％,1867/4268),社区卫生服务中心(25.07％,1070/4268)和社区卫生服务站(20.20％,862/4268)分列第2、3位；复诊机构以社区卫生服务中心(30.72％,1274/4147)和社区卫生服务站(31.11％,1290/4147)为主；药物主要来源于药店(60.23％,3073/5102).农村社区居民高血压首次诊断机构主要为村卫生室(54.58％,2133/3908),乡镇卫生院(22.36％,874/3908)和区(县)级及以上医院(18.86％,737/3908)分列第2、3位；复诊机构以村卫生室(70.49％,2695/3823)为主；药物主要来源于村卫生室(46.23％,2116/4577)和药店(36.29％,1661/4577).我国城乡社区居民选择高血压复诊机构的主要原因为离住所近(方便)(45.79％,6276/13 706)和价格低(11.78％,1614/13 706).城市社区居民既往1年高血压相关住院费用的报销比例为66.67％,高于农村居民(35.71％)(Z=-12.13,P＜0.01)；城乡社区居民既往1年高血压相关治疗总费用(包括门诊和住院费用)报销比例分别为34.78％和9.50％(Z=-17.56,P＜0.01).结论 我国应进一步推进社区高血压筛查与门诊血压检测制度,提高社区层面首诊检出率；加强基层医疗机构建设,便利患者降血压治疗需求,促进高血压防治.
目的 通過對2010年中國5箇省城鄉社區高血壓患者就診機構、就醫現況和醫療保障的比較,旨在為國傢基本公共衛生服務項目高血壓患者健康管理的實施和效果評估提供基礎性數據.方法 于2010年,在我國江囌、山東、河北、四川和甘肅5箇省,主要根據經濟髮展水平,依次抽取市、區縣,最終確定10箇調查點.採用整群抽樣方法,在每箇調查點抽取3～4箇社區或鄉鎮,調查符閤標準的社區高血壓患者8326例,其中城市4363例,農村3963例,針對城鄉高血壓患者的就診機構、就醫現況和醫療保障情況進行比較.結果 城市社區高血壓患者首次診斷機構主要為區(縣)級及以上醫院(43.74％,1867/4268),社區衛生服務中心(25.07％,1070/4268)和社區衛生服務站(20.20％,862/4268)分列第2、3位；複診機構以社區衛生服務中心(30.72％,1274/4147)和社區衛生服務站(31.11％,1290/4147)為主；藥物主要來源于藥店(60.23％,3073/5102).農村社區居民高血壓首次診斷機構主要為村衛生室(54.58％,2133/3908),鄉鎮衛生院(22.36％,874/3908)和區(縣)級及以上醫院(18.86％,737/3908)分列第2、3位；複診機構以村衛生室(70.49％,2695/3823)為主；藥物主要來源于村衛生室(46.23％,2116/4577)和藥店(36.29％,1661/4577).我國城鄉社區居民選擇高血壓複診機構的主要原因為離住所近(方便)(45.79％,6276/13 706)和價格低(11.78％,1614/13 706).城市社區居民既往1年高血壓相關住院費用的報銷比例為66.67％,高于農村居民(35.71％)(Z=-12.13,P＜0.01)；城鄉社區居民既往1年高血壓相關治療總費用(包括門診和住院費用)報銷比例分彆為34.78％和9.50％(Z=-17.56,P＜0.01).結論 我國應進一步推進社區高血壓篩查與門診血壓檢測製度,提高社區層麵首診檢齣率；加彊基層醫療機構建設,便利患者降血壓治療需求,促進高血壓防治.
목적 통과대2010년중국5개성성향사구고혈압환자취진궤구、취의현황화의료보장적비교,지재위국가기본공공위생복무항목고혈압환자건강관리적실시화효과평고제공기출성수거.방법 우2010년,재아국강소、산동、하북、사천화감숙5개성,주요근거경제발전수평,의차추취시、구현,최종학정10개조사점.채용정군추양방법,재매개조사점추취3～4개사구혹향진,조사부합표준적사구고혈압환자8326례,기중성시4363례,농촌3963례,침대성향고혈압환자적취진궤구、취의현황화의료보장정황진행비교.결과 성시사구고혈압환자수차진단궤구주요위구(현)급급이상의원(43.74％,1867/4268),사구위생복무중심(25.07％,1070/4268)화사구위생복무참(20.20％,862/4268)분렬제2、3위；복진궤구이사구위생복무중심(30.72％,1274/4147)화사구위생복무참(31.11％,1290/4147)위주；약물주요래원우약점(60.23％,3073/5102).농촌사구거민고혈압수차진단궤구주요위촌위생실(54.58％,2133/3908),향진위생원(22.36％,874/3908)화구(현)급급이상의원(18.86％,737/3908)분렬제2、3위；복진궤구이촌위생실(70.49％,2695/3823)위주；약물주요래원우촌위생실(46.23％,2116/4577)화약점(36.29％,1661/4577).아국성향사구거민선택고혈압복진궤구적주요원인위리주소근(방편)(45.79％,6276/13 706)화개격저(11.78％,1614/13 706).성시사구거민기왕1년고혈압상관주원비용적보소비례위66.67％,고우농촌거민(35.71％)(Z=-12.13,P＜0.01)；성향사구거민기왕1년고혈압상관치료총비용(포괄문진화주원비용)보소비례분별위34.78％화9.50％(Z=-17.56,P＜0.01).결론 아국응진일보추진사구고혈압사사여문진혈압검측제도,제고사구층면수진검출솔；가강기층의료궤구건설,편리환자강혈압치료수구,촉진고혈압방치.
Objective To investigate the status of the clinical agency of detection,management,and health insurance for hypertensive patients in urban and rural communities of five provinces in China in 2010,in order to provide fundamental data for implementation and evaluation of community health management of hypertensive patients in basic public health service.Methods From Jiangsu,Shandong,Hebei,Sichuan and Gansu provinces,cities and districits (counties) were selected according to economic development level and 10 survey sites were finally determined.In each survey site,3-4 communities or townships were selected by cluster sampling methods in 2010.A total of 8326 eligible hypertensive patients (4363 in urban and 3963 in rural) were included.The urban-rural difference of clinical agency and health insurance was compared for hypertensive patients.Results In urban areas,43.74％ (1867/4268) hypertensive patients were first diagnosed at hospitals of district level or above,25.07％ (1070/4268) at community health service centers (CHSC),and 20.20％ (862/4268) at community health service stations (CHSS),respectively ; 30.72％(1274/4147) and 31.11％ (1290/4147) patients chose CHSC and CHSS for their follow-up visiting,respectively; 60.23％ (3073/5102) antihypertensive medication was obtained from pharmacies.In rural areas,54.58％ (2133/3908) hypertensive patients were first diagnosed at village clinics,22.36％(874/3908) at township hospitals,and 18.86％ (737/3908) at hospitals of county level or above ; 70.49 ％(2695/3823) patients chose village clinics for their follow-up visiting; 46.23％ (2116/4577)antihypertensive medication was obtained from village clinics,and 36.29％ (1661/4577) from pharmacies.The main reasons for choosing clinical agency for both urban and rural patients were convenience (45.79％,6276/13 706) and low cost (11.78％,1614/13 706).The proportions of reimbursements for hospitalization expenses and total medical expenses for hypertensive patients in urban in the past year were 66.67％ and 34.78％,respectively,which were much higher than those in rural (35.71％ and 9.50％)(Z value was-12.13 and-17.56,P ＜ 0.01).Conclusion Community-based hypertension detection and routine blood pressure measurement during clinical visiting should be further strengthened to improve early diagnosis of hypertension.The development of community-based clinical agency should be able to provide convenient and low cost health service for hypertensive patients to improve treatment,follow-up and control of hypertension.
