Abstract: Background Primary health institutions serve as the frontline defense against hypertension and diabetes. Their capabilities is critical to China's ability to effectively prevent and control these two chronic conditions. Objective To analyze the current situation of health management and treatment services provided by community hospitals in China for patients with hypertension and diabetes to identify problems and make suggestions. Methods The "Quality Service Grassroots Activities Application System" collected information on hypertension and diabetes prevention and treatment capacity and service provision in 3718 community hospitals. Descriptive statistical analysis and multiple linear regression analysis were carried out based on Stata15.0 . Results There were statistically significant differences in the allocation of electrocardiogram machines and peripheral blood glucose meters among primary health institutions across different regions (P<0.001). Similarly, significant regional disparities were observed in the availability of essential antihypertensive and hypoglycemic medications (P<0.001). The annual number of hypertension and diabetes diagnoses and treatments per institution also varied significantly by region (P<0.001). Additionally, significant differences were found in the renewal rates of hypertensive and diabetic patients across regions(P<0.001). Furthermore, significant variations were observed among regions in the standardized management rates of hypertensive and diabetic patients, as well as in blood pressure and blood glucose control rates (P<0.001). Multiple linear regression analysis revealed that factors such as region, institution type, the number of essential antihypertensive drugs available, the number of registered general practitioners, the proportion of medical income to total income, the proportion of medical insurance income to medical income, and the contract renewal rate significantly influenced the annual number of diagnosed and treated hypertensive patients (P<0.05). Similarly, region, institution type, the number of practicing (assistant) physicians, the proportion of medical income to total income, and the renewal rate were found to affect the standardized management rate of hypertensive patients (P<0.05). Moreover, region, institution type, the number of electrocardiogram machines, the number of practicing (assistant) physicians, and the proportion of medical income to total income had statistically significant effects on blood pressure control. Conclusion The hardware conditions of community hospitals in the western region are better, but the medical service capacity is not as good as that in the east, and the soft power still needs to be improved. The ECG machine is the best, but the peripheral blood glucose meter, drug equipment, diagnosis and treatment times and other indicators that reflect the ability of medical services are not as good as those in the east. The integration of medical prevention of hypertension and diabetes still needs to be implemented, and public health indicators such as standardized management rate and blood pressure and blood glucose control rate are "decoupled" from the medical service capacity of community hospitals, and the indicators related to medical services and public health services are "inverted", with the former being high in the east and the latter in the west, and the quality and service connotation of public health data need to be improved.

Key words: Hypertension, Diabetes mellitus, Community hospital, Prevention and treatment of chronic diseases;Integration of treatment and prevention

摘要： 背景 基层医疗卫生机构是高血压和糖尿病防治的第一道防线，其诊疗和管理能力直接关系到我国能否有效防控这两种慢性病。目的 分析我国基层医疗卫生机构提供高血压和糖尿病患者健康管理和治疗服务的现状以发现问题并提出建议。方法 本研究采用横断面调查方法，2023年2—4月通过线上调查的方式，按照各省份基层医疗卫生机构（仅指乡镇卫生院和社区卫生服务中心）总数的10%，随机抽取30个省（除西藏自治区）的3 718家基层医疗卫生机构，收集各机构的卫生人力资源［执业（助理）医师、全科医师］、相关设备（心电图机、末梢血糖仪）、收入构成情况（医疗收入占总收入比重及医保基金收入占医疗收入比重）、基本药物配备情况（降血压和降血糖基本药物配备种数）、高血压与糖尿病防治情况（年诊疗高血压和糖尿病人次、家庭医生签约率、高血压和糖尿病患者规范管理率、血压及血糖控制率）等相关信息。基层医疗卫生机构提供高血压、糖尿病诊疗和健康管理服务影响的采用多重线性回归分析。结果 不同区域基层医疗卫生机构心电图机、末梢血糖仪配备情况比较，差异有统计学意义（P<0.001）。不同区域基层医疗卫生机构抗高血压、降血糖基本药物配备情况比较，差异有统计学意义（P<0.001）。不同区域基层医疗卫生机构每机构年诊疗高血压和糖尿病人次比较，差异有统计学意义（P<0.001）。不同区域基层医疗卫生机构高血压和糖尿病患者续约率比较，差异有统计学意义（P<0.001）。不同区域基层医疗卫生机构高血压患者规范管理率、血压控制率、糖尿病患者规范管理率、血糖控制率比较，差异有统计学意义（P<0.001）。多重线性回归分析结果显示，区域、机构类型、抗高血压基本药物配备品种数、注册全科医师数、医疗收入占总收入比重、医保收入占医疗收入的比重和签约续约率对年诊疗高血压病人次有影响（P<0.05）。区域、机构类型、执业（助理）医师数、医疗收入占总收入比重和续约率对高血压患者规范管理率有影响（P<0.05）。区域、机构类型、心电图机的数量、执业（助理）医师数和医疗收入占总收入比重对血压控制率有影响统计学意义（P<0.05）。区域、机构类型、降血糖基本药物配备品种数、执业（助理）医师数、注册全科医师数、签约续约率、医疗收入占总收入比重和医保收入占医疗收入比重对基层医疗卫生机构年诊疗糖尿病人次有影响（P<0.05）。区域、机构类型、执业（助理）医师数、医疗收入占总收入比重和续约率对糖尿病患者规范管理率有影响（P<0.05）。区域、机构类型、执业（助理）医师数和医疗收入占总收入比重对血糖控制率有影响（P<0.05）。结论 西部地区基层医疗卫生机构硬件条件较优，但医疗服务能力不如东部，软实力仍待提升。高血压和糖尿病医防融合仍待落地，规范管理率和血压、血糖控制率等公共卫生指标与基层医疗卫生机构医疗服务能力“脱钩”，公共卫生数据质量和服务内涵有待提高。

关键词: 高血压, 糖尿病, 基层医疗卫生机构, 慢性病防治, 医防融合