Hypertension and diabetes are two major chronic diseases affecting population health, and need to be controlled through chronic diseases follow-up. However, there is currently insufficient understanding of the impact of different chronic diseases follow-up forms and contents on disease control and healthy behaviors of patients.
To explore the impact of the chronic diseases follow-up on health behaviors and blood pressure/glucose control of patients with hypertension and diabetes in the context of treatment-prevention integration.
Yiyang County in Henan Province, Xianfeng County in Hubei Province and Yangqu County in Shanxi Province were selected as study sites to collect data from the basic public health information system from 2017-01-01 to 2022-06-30. Patient survey was conducted in July 2022 to collect information on basic public health follow-up receiving, health behaviors and disease control of patients. Finally, 102 769 patients with hypertension and 26 586 patients with diabetes were obtained from the basic public health information system, the data of 1 172 patients with hypertension and 456 patients with diabetes were obtained through patient surveys. Multivariate Logistic regression was used to analyze the effects of the standard-reaching frequency of follow-up, follow-up forms and contents on health behaviors and disease control of patients.
In 2021, the standard-reaching rates of follow-up frequency of patients with hypertension and diabetes were 90.83% (67 709/74 545) and 83.35% (13 390/16 065) , with frequency≥4 times/year as the standard. The follow-up forms included household follow-up〔25.74% (408/1 585) 〕, follow-up at institutional visits〔58.80% (932/1 585) 〕, telephone or network follow-up〔15.46% (245/1 585) 〕. The follow-up contents included blood pressure and blood glucose measurements〔91.15% (1 484/1 628) 〕, lifestyle guidance〔74.14% (1 207/1 628) 〕, disease inquiry〔70.02% (1 140/1 628) 〕, and drug use understanding〔69.29% (1 128/1 628) 〕. Multivariate Logistic regression analysis showed that patients with higher standard-reaching rates of follow-up frequency had higher rates of blood pressure control (OR=1.09, P<0.05) and glucose control (OR=1.31, P<0.05) , lower rates of smoking and drinking (OR=0.83, P<0.05) , and higher rates of regular exercise habits (OR=1.30, P<0.05) . The proportions of smoking and alcohol cessation (OR=2.38, P<0.05) and regular exercise habits (OR=1.62, P<0.05) were higher in the patients followed up at institutional visits than those followed up by telephone or network. The proportions of smoking and alcohol cessation (OR=2.33, P<0.05) and regular exercise habits (OR=2.54, P<0.05) of patients received household follow up were higher than those followed up by telephone or network. Patients who received lifestyle guidance, disease inquiry, and drug use understanding had higher rates of blood pressure control (OR=1.61, 1.34, and 1.62, respectively; P<0.05) , smoking and alcohol cessation (OR=3.59, 3.54, and 2.91, respectively; P<0.05) and regular exercise habits (OR=3.16, 2.15, 2.45, respectively; P<0.05) .
Receiving chronic diseases follow-up at least 4 times per year, with follow-up at institutional visits and household follow-up as the forms, provided with blood pressure and blood glucose measurements, lifestyle guidance, disease inquiry and drug use understanding as the contents in patients were positive correlated with blood pressure/glucose control, smoking and alcohol cessation, and regular exercise habits.
Currently, scholars in China are exploring chronic disease management models based on treatment-prevention integration, however, the quantitative evaluation researches are scarce and in the initial stage, lacking in relevance and timeliness.
To construct the on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions and provide a reference for the quality improvement of integration of medical and preventive services.
The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was initially constructed by literature review, policy induction and expert interview. From June to August 2022, two rounds of expert consultation with 17 experts were conducted using the Delphi method, the index system was determined according to the results of expert consultation, and the weight of each index was calculated by using the analytic hierarchy process.
The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was initially constructed consisting of 5 primary indexes, 12 secondary indexes and 37 tertiary indexes. The effective questionnaire recovery rate of the two rounds of expert consultation was 100.0% with the expert authority coefficient of 0.81; the Kendall coordination coefficients of the importance of the three levels of indexes were 0.239 (χ2=8.76, P<0.05) and 0.275 (χ2=4.15, P<0.05) , the Kendall coordination coefficients of the feasibility of the three levels of indexes were 0.234 (χ2=19.63, P<0.05) and 0.248 (χ2=12.43, P<0.05) . The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was finally constructed consisting of 5 primary indexes, 12 secondary indexes and 40 tertiary indexes, the weight of the five primary indicators was 0.200 0.
The evaluation index system has a certain practical guidance for the improvement of the capacity of integration of medical and preventive services for chronic diseases in urban and rural community health service institutions. However, the evaluation index system should also be dynamically adjusted according to the specific situation to effectively reflect the quality of integration of medical and preventive services for chronic diseases in primary health care institutions.
Since August 2022, Shengzhou City of Zhejiang Province has been carrying out the reform of outpatient payment mode in medical insurance, gradually carrying out the reform of capitation by implementing the total budget, updating the calculation standard of capitation fee, improving the incentive and constraint mechanism and other measures, so as to encourage primary health care institutions to provide appropriate basic medical services, reduce primary medical expenses, and promote the sustainable development of medical insurance fund.
To analyze the influence mechanism of capitation for outpatient services in basic medical insurance on medical expenses in Shengzhou City, Zhejiang Province, and to provide reference for improving the relevant payment system.
Using "capitation" and "medical costs" as both English and Chinese search terms, databases such as CNKI, Wanfang, PubMed and Web of Science were searched for relevant literature on capitation from 2000-01-01 to 2022-07-31, as well as the policy documents, government reports and news reports related to the implementation of capitation from April to July 2022. Personal interviews were conducted with representatives of capitation payment policy makers and implementers in Shengzhou City from September to December 2022 (n=13) . A qualitative analysis of capitation reform policy on medical expenses under the total outpatient budget in Shengzhou City, Zhejiang Province was performed by using system dynamics approach.
The policies of the current round of medical insurance payment reform in Shengzhou were plotted as a cause graph with five feedback loops obtained, showing that the implementation of the total capitation budget policy can motivate primary health care institutions to provide standardized medical services for residents, promote an increase in the contracting rate in primary care, thus controling medical expenses; a scientific capitation fee standard can motivate primary health care institutions to autonomously control and reduce costs; increasing the reimbursement ratio of medical insurance can effectively reduce the medical burden of patients; improving the performance appraisal system is conducive to the continuous improvement of service capabilities of primary health care institutions; strengthening the construction of information sharing mechanisms can achieve data sharing and exchange, and comprehensively improve the health of residents.
The implementation of capitation reform in conjunction with multiple policy measures can improve the contracting and consultation rates in primary care institutions, broaden the sources of medical insurance fund, ensure the sustainability of medical insurance fund, improve the medical service and capabilities of primary care institutions, improve the health status of residents, and significantly improve the prevention and treatment effect of chronic diseases.
The persistent elevation of the prevalence of chronic non-communicable diseases and sudden pandemic of COVID-19 infections have once again attracted the attention of the whole society to prevention activities closely associated with epidemic prevention. Although the correlation between prevention and treatment of health is a long-term topic, innovation and mechanism of treatment-prevention integration proposed by Chinese health administration after the peak of COVID-19 epidemic has attracted attention and reflections of the medical and academic fields. Medical treatment and prevention are inseparable. The questions such as how to achieve the coordination and balance between treatment and prevention, what is the solution of treatment-prevention integration, are worth further study and exploration. Beginning with clarifying the concept of treatment and prevention, this paper analyzes the reasons for the separation of treatment and prevention, explores the approaches for effective connection and cooperative interaction between the two, thus providing further research directions for general practice researchers, calling on colleagues in general practice to contribute their wisdom and promote the contribution of treatment-prevention integration to healthy China.
The integration mechanism of medical treatment and prevention based on family doctor teams is a key way to break down the barrier between "medical" and "prevention". In this paper, we explain the definition and connotation of treatment-prevention integration, review the development history of family doctor teams, systematically review the typical practice strategies and the shortcomings of treatment-prevention integrationon family doctor teams in China. Measures should be taken to promote the treatment-prevention integration, including improve the talent training system, change views of "attaching importance to treatment and neglecting prevention", strengthen the organization and management, innovate the assessment and incentive mechanism, reform the medical insurance payment method, encourage diversified forms of services, etc. The study aims to provide reference for improving the quality of services and developing treatment-prevention integration in the future.
In 2019, the National Health Commission launched the construction of compact county medical alliance to strengthen chronic diseases management in primary care, and the construction of chronic disease management models varies among county medical alliance sites. Xindu District, as one of the first national compact county medical alliance sites in Sichuan Province, has explored both dimensions of theoretical and practical innovation in the construction of the innovative model of chronic disease management in compact county medical alliance with treatment-prevention integration, providing a new approach for the innovative development of primary compact county medical alliance in China.
To analyze the innovation model and its effectiveness of chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District with the experience of international integrated medical models.
The chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District was constructed with "one center, two integration, three reforms and four safeguard mechanisms" under the leadership of Xindu District Health Bureau, to strengthen the management of chronic diseases mainly including hypertension and diabetes.
As of June 2022, the number of hypertension or diabetes patients under standardized management in the district increased by 50.87% compared with the initial stage of construction, the number of hypertension or diabetes patients increased by 55.28% and 49.04%, respectively; while the proportion of patients with HbA1c<7% or BP<140/90 mmHg (1 mmHg=0.133 kPa) increased by 70.69% and 115.28% in the past year among them, respectively. The outpatient visits of primary care increased by 14.30% in one year, among which the outpatient visits for hypertension or diabetes increased by 36.01%; while downward referrals within medical communities increased by 14.55%, creating a number of demonstration units for the transformation of treatment-prevention integration in primary care.
The innovative model of chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District has a significant effect on improving the quality and efficiency of chronic disease management in primary care.
