基于半结构化访谈法的卫生体系视角下我国基层高血压管理模式的实施现状、问题分析及政策建议
he Current Status Analysis and Policy Recommendations of in Hypertension Control and Management in Primary Health Care in China from the Perspective of Health System Based on The Semi-structured Interview
背景 高血压是影响我国居民健康最常见的慢性非传染性疾病，基层作为高血压管理与控制的重要关口，其管理能力直接影响着管理效果。现阶段我国基层高血压管理模式运作现状和共性规律仍有待进一步探究。目的 了解我国基层高血压管理现状，梳理典型经验，为我国高血压管理优化提供建议。方法 2021年11-12月，对我国五省市29位高血压管理利益相关者进行半结构化访谈，以世界卫生组织卫生体系理论为指导，从领导治理、服务提供、卫生人力、卫生筹资、药物和设备可及性以及卫生信息系统等六个维度进行分析。结果 在领导治理层面，基层高血压管理工作的开展主要依托于家庭医生签约服务，并与多部门协同管理；在服务提供层面，提供全专融合服务以满足患者个性化医疗需求；在卫生人力层面，社区全科医生是基层高血压管理工作开展的主力，通过绩效考核按劳分配提高工作积极性；在卫生筹资方面，高血压患者在基层就诊可获得医保报销倾斜性政策支持；在药物可及性方面，基本医疗设备及高血压基本用药在基层均有配备；在卫生信息系统方面，区域医疗卫生信息平台可实现签约患者健康信息共享与服务协同。结论 基层医疗卫生机构承担着对高血压患者长期随访管理的工作，可通过进一步提升基层卫生综合治理能力与基层卫生服务供给能力，加强基层卫生人员能力建设，完善医保报销与支付方式制度，改善基层高血压治疗的药物和设备条件，并通过信息化建设有效赋能基层高血压管理，进一步提升基层高血压管理水平。
Background Hypertension is the most common chronic non-communicable disease affecting the health of the people in China. As an important point for hypertension management and control, the management ability of primary care directly affects the management effect. The current status and common rules of hypertension management in primary care in China need to be further explored. Objective To understand the current status of hypertension management in primary care in China, summarize the typical experience, and provide suggestions for the optimization of hypertension management in China. Methods From November to December 2021, semi-structured interviews were conducted with 29 hypertension management stakeholders in five provinces in China. Guided by the World Health Organization's health system, the interviews were analyzed from six dimensions: leadership and governance, service delivery, health workforce, financing, access to essential medicine, and health information system. Results For leadership and governance, hypertension management at primary level mainly relied on contracted family doctor service and multi-department collaboration. In terms of service provision, general practice and specialty integration services should be provided to meet the individual medical needs of patients. For health workforce, community general practitioners are the main force of hypertension management in primary care, and their work enthusiasm is improved by performance appraisal and distribution according to their work. For financing, hypertensive patients can obtain preferential policy support of medical insurance reimbursement at primary care. For accessibility, basic medical equipment and essential hypertension drugs were equipped at primary level. For health information system, the regional medical and health information platform can realize health information sharing and service coordination of contracted patients. Conclusions Primary health care institutions are responsible for the long-term follow-up and management of hypertension patients. It is necessary to further enhance the capacity of primary health care comprehensive management and primary health service supply, strengthen the capacity building of primary health care personnel, improve the reimbursement and payment system of medical insurance, and improve the drug and equipment conditions for hypertension treatment in primary care. It can effectively empower primary hypertension management and further improve the level of primary hypertension management.
谷明宇、李星明、乔昆、白欣苑、王尧、秦廷廷、杨宇彤
医药卫生理论医学研究方法医学现状、医学发展
卫生体系高血压基层医疗机构慢病管理
谷明宇,李星明,乔昆,白欣苑,王尧,秦廷廷,杨宇彤.基于半结构化访谈法的卫生体系视角下我国基层高血压管理模式的实施现状、问题分析及政策建议[EB/OL].(2023-01-03)[2025-08-16].https://chinaxiv.org/abs/202301.00061.点此复制
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