發(fā)布時(shí)間：2018-01-23 22:05

  本文關(guān)鍵詞： WHO PEN 慢性病 評(píng)價(jià)體系　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景近年來(lái),慢性疾病已逐漸成為們國(guó)家居民主要的死因之一�！癢HO PEN”項(xiàng)目選擇寧夏青銅峽市作為樣本地區(qū)進(jìn)行糖尿病和高血壓的干預(yù)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(yù)模式。但其干預(yù)效果如何?是否達(dá)到WHO PEN干預(yù)工具包的最終目標(biāo)?需要我們從項(xiàng)目的各個(gè)環(huán)節(jié)進(jìn)行綜合分析評(píng)價(jià),這對(duì)寧夏農(nóng)村地區(qū)慢性病干預(yù)模式的建立具有重要意義。目的本研究在對(duì)“WHO PEN”項(xiàng)目的管理體制和方案設(shè)計(jì)的基礎(chǔ)上,選擇代表性評(píng)價(jià)指標(biāo),建立評(píng)價(jià)指標(biāo)體系,按照條件-過(guò)程-結(jié)果的評(píng)價(jià)原理對(duì)其實(shí)施效果進(jìn)行系統(tǒng)的客觀評(píng)價(jià),同時(shí)將“WHO PEN”項(xiàng)目與國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目中慢性病的干預(yù)相分離,找到兩者干預(yù)的差距,為寧夏農(nóng)村地區(qū)慢性病防控提供理論基礎(chǔ)與實(shí)踐指導(dǎo)。方法定性分析:現(xiàn)場(chǎng)調(diào)查法收集項(xiàng)目實(shí)施的基本情況、樣本地區(qū)管理人員、醫(yī)務(wù)人員和居民的相關(guān)資料,德?tīng)柗品êY選、確定最終建立評(píng)價(jià)指標(biāo)體系,描述性分析法分析條件、過(guò)程和結(jié)果指標(biāo);定量分析:單因素和多因素logistic回歸分析進(jìn)行慢性病高危因素篩查分析,因子分析法分析項(xiàng)目管理人員和工作人員滿意度情況,成本-效果法進(jìn)行經(jīng)濟(jì)學(xué)評(píng)價(jià),差異分析法對(duì)本項(xiàng)目與國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目進(jìn)行交叉效果評(píng)價(jià)。結(jié)果1.通過(guò)德?tīng)柗品ń�立“WHO PEN”項(xiàng)目評(píng)價(jià)指標(biāo)體系,包括條件、過(guò)程、結(jié)果3個(gè)一級(jí)指標(biāo);組織管理、項(xiàng)目基線調(diào)查、項(xiàng)目實(shí)施情況等11個(gè)二級(jí)指標(biāo);內(nèi)部管理制度、設(shè)備、藥品、成本效果分析等41個(gè)三級(jí)指標(biāo);設(shè)備前后對(duì)比情況、高血壓相關(guān)因素分析等9個(gè)四級(jí)指標(biāo)。2.項(xiàng)目成立干預(yù)領(lǐng)導(dǎo)小組和專業(yè)技術(shù)指導(dǎo)組負(fù)責(zé)項(xiàng)目的具體實(shí)施工作;總經(jīng)費(fèi)為45.36萬(wàn)元,無(wú)違規(guī)經(jīng)費(fèi)使用,但經(jīng)費(fèi)下?lián)懿患皶r(shí),導(dǎo)致樣本地區(qū)墊付資金開(kāi)展項(xiàng)目活動(dòng);項(xiàng)目共開(kāi)展四項(xiàng)培訓(xùn)活動(dòng),共培訓(xùn)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(wàn)份;開(kāi)展慢性病患者自我管理小組8個(gè),參與患者達(dá)610人。3.結(jié)果評(píng)價(jià):干預(yù)前后設(shè)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(yù)后高血壓/糖尿病知識(shí)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(gè)指標(biāo)與血壓升高有關(guān),肥胖、糖尿病家族史、吸煙和每日水果攝入量4個(gè)指標(biāo)與血糖升高有關(guān);項(xiàng)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(fèi)協(xié)調(diào)因子滿意度較差;經(jīng)濟(jì)學(xué)評(píng)價(jià)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(yù)初期,效果較明顯;兩病排除兩項(xiàng)目政策交叉效果后,均為本項(xiàng)目干預(yù)效果較好;項(xiàng)目實(shí)施效果的影響因素主要有項(xiàng)目管理因素、經(jīng)費(fèi)因素、干預(yù)技術(shù)提供方和需求方因素。建議1.經(jīng)費(fèi)撥付應(yīng)及時(shí),避免項(xiàng)目樣本地區(qū)衛(wèi)生院墊付資金開(kāi)展項(xiàng)目活動(dòng);2.提高鄉(xiāng)鎮(zhèn)衛(wèi)生院臨床服務(wù)和公共衛(wèi)生服務(wù)能力,提高衛(wèi)生資源的合理配置;3.根據(jù)地方實(shí)際情況,進(jìn)一步修改基本藥品目錄;4.慢性病患者自我管理應(yīng)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(xiàng)目資金設(shè)計(jì)一個(gè)WHO PEN慢性病管理信息系統(tǒng),根據(jù)不同人群的不同特點(diǎn),從篩查、干預(yù)治療、隨訪及預(yù)后每一個(gè)過(guò)程入手,設(shè)計(jì)一套適合寧夏農(nóng)村地區(qū)慢性病干預(yù)的管理信息系統(tǒng)。6.將適宜技術(shù)加入到WHO PEN慢性病的防控與干預(yù)中,將本項(xiàng)目中的藥品清單與適宜技術(shù)的藥品結(jié)合到一起,更好的為慢病患者提供治療服務(wù)。
[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(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R197.1

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本文編號(hào)：1458346