社区“互联网+”慢性病管理的问题与对策调查研究
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摘要
目的:分析社区"互联网+"创新性技术慢病管理现状、效果与问题,提出对策与建议。方法:采用典型抽样调查方法,对医务人员和患者进行调查,对医患双方知晓、利用和慢性病管理效果进行分析。结果:医务人员认为"互联网+"主要用于诊断与治疗(25.58%)、健康管理(24.03%)和健康教育与咨询(22.87%)。在利用临床辅助诊疗系统(CDSS)开展服务、心脑血管疾病风险评估、分时段预约、慢性病患者智能化随访、远程影像或心电诊断等方面,医务人员的利用率分别为33.72%、58.14%、66.28%、72.48%和30.62%。在患者心脑血管疾病风险评估、分时段预约、慢性病患者智能化随访、远程影像或心电诊断、电子药盒提醒等方面,患者利用率分别为20.36%、11.95%、13.95%、3.30%和53.00%。利用"互联网+"随访管理的患者高血压控制率高于未利用组(c~2=11.061,P=0.001);开展心脑血管疾病风险评价的糖尿病患者血糖控制率高于未开展组(c~2=15.255,P=0.000);利用电子药盒提醒的糖尿病患者血糖控制率也高于未利用组(c~2=4.070,P=0.044)。结论与建议:"互联网+"慢性病管理技术医务人员利用率较高,而患者利用率较低,地区发展不均衡;医生端"互联网+"管理技术的应用改善了高血压和糖尿病的控制效果;建议推进医生端"互联网+"慢性病患者管理技术,改进患者端的可操作性,在社区开展心脑血管疾病综合管理试点。
Objective: To analyze the current status, effectiveness and problems of "Internet+" based chronic disease management in community healthcare settings and put forward policy recommendations. Methods: Based on typical sampling method, medical staff and doctors were investigated to analyze the awareness, the utilization and management effects of doctors and patients. Results:Medical staff considered that "internet+" were mainly applied in diagnosis and treatment(25.88%), health management(24.03%) and health education and consultation(22.87%). In terms of Clinical Decision Support System(CDSS), risk evaluation of cardiovascular diseases, "internet+" based appointment, intellectual follow-up of chronic disease management, tele-communication-based imaging and ECG diagnosis; the utilization rates of health staff were 33.72%, 58.14%, 66.28%, 72.48% and 30.62%, respectively. In terms of risk evaluation of cardiovascular diseases, "internet+" based appointment, intellectual follow-up of chronic disease management,and tele-communication-based imaging and ECG diagnosis and electronic reminding equipment, the utilization rates of patients were20.36%, 11.95%, 13.95%, 3.30% and 53.00%, respectively. Patients who utilized "Internet+" chronic disease management system had a higher control rate of hypertension compared with those not utilized(c~2=11.061, P=0.001); risk prediction tools had played a role in diabetes control(c~2=15.255,P=0.000); and electronic reminding equipment had played a role in diabetes control as well(c~2=4.070,P=0.044). Conclusion and Suggestion: The utilization of "Internet+" technologies were high among health professionals, but low in patients, and there was an imbalance in the development of "Internet+" technology among different areas in China. The use of "Internet+"technologies improved control of hypertension and diabetes. It was recommended that "Internet+" technology should be health staff oriented and focusing on comprehensive interventions on risk factors of cardiovascular disease.
Objective: To analyze the current status, effectiveness and problems of "Internet+" based chronic disease management in community healthcare settings and put forward policy recommendations. Methods: Based on typical sampling method, medical staff and doctors were investigated to analyze the awareness, the utilization and management effects of doctors and patients. Results:Medical staff considered that "internet+" were mainly applied in diagnosis and treatment(25.88%), health management(24.03%) and health education and consultation(22.87%). In terms of Clinical Decision Support System(CDSS), risk evaluation of cardiovascular diseases, "internet+" based appointment, intellectual follow-up of chronic disease management, tele-communication-based imaging and ECG diagnosis; the utilization rates of health staff were 33.72%, 58.14%, 66.28%, 72.48% and 30.62%, respectively. In terms of risk evaluation of cardiovascular diseases, "internet+" based appointment, intellectual follow-up of chronic disease management,and tele-communication-based imaging and ECG diagnosis and electronic reminding equipment, the utilization rates of patients were20.36%, 11.95%, 13.95%, 3.30% and 53.00%, respectively. Patients who utilized "Internet+" chronic disease management system had a higher control rate of hypertension compared with those not utilized(c~2=11.061, P=0.001); risk prediction tools had played a role in diabetes control(c~2=15.255,P=0.000); and electronic reminding equipment had played a role in diabetes control as well(c~2=4.070,P=0.044). Conclusion and Suggestion: The utilization of "Internet+" technologies were high among health professionals, but low in patients, and there was an imbalance in the development of "Internet+" technology among different areas in China. The use of "Internet+"technologies improved control of hypertension and diabetes. It was recommended that "Internet+" technology should be health staff oriented and focusing on comprehensive interventions on risk factors of cardiovascular disease.
引文
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[6]陈子豪,赵婷,贾静,等.“互联网+”慢性病管理模式的发展及现状综述[J].昆明学院学报,2018,40(3):109-114.
[7]黄正明.慢病的防控与合理救治[J].中国医药科学,2012,5(2):9-10.
[8]TIAN M,WANG H,TONG X,et al.Essential public health services’Accessibility and its determinants among adults with chronic diseases in China[J].Plos one,2015,10(4):e0125262.
[9]王海清.基于互联网的社区高血压自我管理干预模式简历与评价[D].广州:暨南大学,2017:14-23.
[10]ANCHALA R,KAPTOGE S,PANT H,et al.Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings:results from a cluster randomized trial[J].Journal of the American heart association,2015(4):1-19.
[11]World Health Organization.Choosing interventions that are cost effective(WHO-CHOICE)[EB/OL].[2019-01-15].http://www.who.int/choice/costs/ppp/en/.
[2]秦江梅,张丽芳,林春梅,等.新医改以来我国基层卫生人力发展规模及配置现状研究[J].中国全科医学,2016,19(4):378-381.
[3]王高玲,张怡青.基于“互联网+”的慢性非传染性疾病管理体系构建[J].中国卫生经济,2017,36(10):69-72.
[4]《中国高血压基层管理指南》修订委员会.《中国高血压基层管理指南》(2014年修订版)[J].临床荟萃,2015,30(7):725-744.
[5]中华医学会糖尿病学会.中国2型糖尿病防治指南(2013年版)[J].中国医学前沿杂志(电子版),2015,7(3):26-88.
[6]陈子豪,赵婷,贾静,等.“互联网+”慢性病管理模式的发展及现状综述[J].昆明学院学报,2018,40(3):109-114.
[7]黄正明.慢病的防控与合理救治[J].中国医药科学,2012,5(2):9-10.
[8]TIAN M,WANG H,TONG X,et al.Essential public health services’Accessibility and its determinants among adults with chronic diseases in China[J].Plos one,2015,10(4):e0125262.
[9]王海清.基于互联网的社区高血压自我管理干预模式简历与评价[D].广州:暨南大学,2017:14-23.
[10]ANCHALA R,KAPTOGE S,PANT H,et al.Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings:results from a cluster randomized trial[J].Journal of the American heart association,2015(4):1-19.
[11]World Health Organization.Choosing interventions that are cost effective(WHO-CHOICE)[EB/OL].[2019-01-15].http://www.who.int/choice/costs/ppp/en/.