本文關鍵詞： WHO PEN 慢性病 評價體系　出處：《寧夏醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：背景近年來,慢性疾病已逐漸成為們國家居民主要的死因之一�！癢HO PEN”項目選擇寧夏青銅峽市作為樣本地區(qū)進行糖尿病和高血壓的干預研究,最終探索一套適合寧夏農(nóng)村地區(qū)慢性疾病的干預模式。但其干預效果如何?是否達到WHO PEN干預工具包的最終目標?需要我們從項目的各個環(huán)節(jié)進行綜合分析評價,這對寧夏農(nóng)村地區(qū)慢性病干預模式的建立具有重要意義。目的本研究在對“WHO PEN”項目的管理體制和方案設計的基礎上,選擇代表性評價指標,建立評價指標體系,按照條件-過程-結果的評價原理對其實施效果進行系統(tǒng)的客觀評價,同時將“WHO PEN”項目與國家基本公共衛(wèi)生服務項目中慢性病的干預相分離,找到兩者干預的差距,為寧夏農(nóng)村地區(qū)慢性病防控提供理論基礎與實踐指導。方法定性分析:現(xiàn)場調(diào)查法收集項目實施的基本情況、樣本地區(qū)管理人員、醫(yī)務人員和居民的相關資料,德爾菲法篩選、確定最終建立評價指標體系,描述性分析法分析條件、過程和結果指標;定量分析:單因素和多因素logistic回歸分析進行慢性病高危因素篩查分析,因子分析法分析項目管理人員和工作人員滿意度情況,成本-效果法進行經(jīng)濟學評價,差異分析法對本項目與國家基本公共衛(wèi)生服務項目進行交叉效果評價。結果1.通過德爾菲法建立“WHO PEN”項目評價指標體系,包括條件、過程、結果3個一級指標;組織管理、項目基線調(diào)查、項目實施情況等11個二級指標;內(nèi)部管理制度、設備、藥品、成本效果分析等41個三級指標;設備前后對比情況、高血壓相關因素分析等9個四級指標。2.項目成立干預領導小組和專業(yè)技術指導組負責項目的具體實施工作;總經(jīng)費為45.36萬元,無違規(guī)經(jīng)費使用,但經(jīng)費下?lián)懿患皶r,導致樣本地區(qū)墊付資金開展項目活動;項目共開展四項培訓活動,共培訓人員290人;高危因素共篩查4418人;健康教育共宣傳5024人,發(fā)放宣傳資料2.01萬份;開展慢性病患者自我管理小組8個,參與患者達610人。3.結果評價:干預前后設備配備情況較好,但由于政策限制,藥品總體配備率較低;干預后高血壓/糖尿病知識知曉率分別提高到78.48%和79.85%;高危因素篩查發(fā)現(xiàn)吸煙、高血壓家族史、吸煙、高脂高鹽飲食和性別5個指標與血壓升高有關,肥胖、糖尿病家族史、吸煙和每日水果攝入量4個指標與血糖升高有關;項目工作人員居民滿意度總均分在4.25-4.83之間;因子分析發(fā)現(xiàn)整體滿意度為3.879,經(jīng)費協(xié)調(diào)因子滿意度較差;經(jīng)濟學評價發(fā)現(xiàn)兩病C期均與A期成本效果好,其主要原因由于A期為干預初期,效果較明顯;兩病排除兩項目政策交叉效果后,均為本項目干預效果較好;項目實施效果的影響因素主要有項目管理因素、經(jīng)費因素、干預技術提供方和需求方因素。建議1.經(jīng)費撥付應及時,避免項目樣本地區(qū)衛(wèi)生院墊付資金開展項目活動;2.提高鄉(xiāng)鎮(zhèn)衛(wèi)生院臨床服務和公共衛(wèi)生服務能力,提高衛(wèi)生資源的合理配置;3.根據(jù)地方實際情況,進一步修改基本藥品目錄;4.慢性病患者自我管理應采用專業(yè)視頻的形式,呈現(xiàn)為圖、文、聲并茂,便于理解;5.WHO追加項目資金設計一個WHO PEN慢性病管理信息系統(tǒng),根據(jù)不同人群的不同特點,從篩查、干預治療、隨訪及預后每一個過程入手,設計一套適合寧夏農(nóng)村地區(qū)慢性病干預的管理信息系統(tǒng)。6.將適宜技術加入到WHO PEN慢性病的防控與干預中,將本項目中的藥品清單與適宜技術的藥品結合到一起,更好的為慢病患者提供治療服務。
[Abstract]:Background: in recent years, chronic disease has gradually become one of the main causes of death. Country residents "intervention study on WHO PEN" project in Ningxia Qingtongxia City as a sample area for diabetes and hypertension, to explore a set of suitable for chronic diseases in Ningxia rural areas of intervention mode. But the effect of intervention? The ultimate goal is to WHO PEN intervention kit? We need to evaluate from all aspects of the project to conduct a comprehensive analysis, the establishment of the intervention of chronic diseases in rural area of Ningxia has important significance. The purpose of this study is based on the design of the management system and the scheme of "WHO PEN" of the project, the selection of representative evaluation indicators, establish evaluation index system according to the objective. The evaluation system for the effect of the implementation of the principle of evaluation process the results of the "WHO PEN" project and the national basic public health service Chronic disease intervention project phase separation, the two find intervention gap, provide theoretical basis and practical guidance for the prevention and control of chronic diseases in rural area of Ningxia. The qualitative analysis method: the basic situation of field investigation to collect the implementation of the project management area, samples and related data of medical staff and residents, the Delphi method to determine the final selection, evaluation the index system, descriptive analysis, process and outcome indicators; quantitative analysis: univariate and multivariate logistic regression analysis was performed to analyze the risk factors of chronic disease screening, factor analysis of project management and staff satisfaction, evaluate the pharmacoeconomic cost-effectiveness method, difference analysis for cross effect evaluation of the project with the national basic public health services. The 1. through the Delphi method to establish "WHO PEN" project evaluation index system, including the condition That process, the results of 3 level indicators; organization management, baseline survey project, the project implementation of 11 level two indexes; the internal management system, equipment, drugs, cost effect analysis of 41 level three indexes; comparison of equipment before and after the 9 level four indexes.2. project related factors analysis of hypertension intervention was established leadership team and professional technical guidance group is responsible for the specific implementation of the project; the total budget is 453 thousand and 600 yuan, no illegal use of funds, but the funds allocated is not timely, resulting in the sample area to advance funds to carry out project activities; the project conducted a total of four training activities, training a total of 290 people 4418 people were screened; risk factors; health education the propaganda of 5024 people, distributed 20 thousand and 100 copies of promotional materials; carry out self management group of 8 patients with chronic disease, to participate in the evaluation results of.3. patients up to 610 people before and after the intervention: equipment is better, but because of policy restrictions, total drug The body is equipped with a low rate; dry rate were increased to 78.48% and 79.85% to know the prognosis of hypertension / diabetes knowledge; risk factor screening found that smoking, smoking, family history, hypertension, high fat and high salt diet and sex 5 indicators associated with the increase of blood pressure, obesity, family history of diabetes, smoking and daily intake of fruits and 4 indicators hyperglycemia; resident satisfaction project staff total score between 4.25-4.83; factor analysis shows that the overall satisfaction was 3.879, funding coordination factors of poor satisfaction; economic evaluation found that two disease C phase with A phase cost effect is good, the main reason for early intervention because of A, the effect is obvious; two cross project policy effect excluding the two disease, were the better effect of intervention in the project; the project implement effect are the main factors of project management factors, financial factors, intervention technology supplier and demand side factors. 1. Allocation of funds should be timely, avoid project sample area hospitals to advance funds to carry out the project activities; 2. township hospital clinical services and public health services, improve the rational allocation of health resources; 3. according to the local actual situation, further modify the basic drug list; 4. patients with chronic disease self management should use the professional video format for presentation map, text, voice and 5.WHO, easy to understand; additional project funding to design a WHO PEN chronic disease management information system, according to the different characteristics of different groups of people, from screening, treatment, follow-up and prognosis of every process of design a chronic disease intervention in Ningxia rural area management information system suitable for.6. technology into the prevention and intervention of chronic disease in WHO PEN, the project in the list of drugs and drug appropriate technology are combined together, the better for patients with chronic disease and provide treatment Medical service.

【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R197.1

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