中国慢性非传染性疾病预防控制能力评估

司向; 翟屹; 施小明

Abstract

司向,翟屹,施小明.中国慢性非传染性疾病预防控制能力评估[J].Chinese journal of Epidemiology,2014,35(6):675-679

中国慢性非传染性疾病预防控制能力评估

Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control，in China

Received:November 05, 2013

DOI：

KeyWord: 慢性非传染性疾病预防控制

English Key Word: Chronic non-communicable diseases Prevention Control

FundProject:

Author Name	Affiliation	E-mail
Si Xiang	Division of Chronic Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Zhai Yi	Division of Chronic Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Shi Xiaoming	Division of Chronic Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China	sxmcdc@163.com

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Abstract:

目的了解我国慢性非传染性疾病（慢性病）预防控制政策能力，各级疾病预防控制中心（CDC）和基层医疗卫生机构慢性病预防控制能力现状。方法通过网络问卷调查全国省、地（市）和县（区）级3 352 家CDC及1 200 家基层医疗卫生机构。结果（1）政策能力：省、地（市）和县（区）级政府配置慢性病预防控制专项经费的比例为75.0%、19.7%和11.3%。（2）基础配置能力：7.1%的县（区）级CDC设有慢性病预防控制科（所）。2009 年各级CDC有8 263 人从事慢性病预防控制工作，占CDC总在岗人员的4.2%。全国CDC有40.2%配置了慢性病预防控制专项经费。（3）培训指导能力：省级CDC举办慢性病预防控制培训班的比例（96.9%）高于地（市）（50.3%）和县（区）级（42.1%）。48.3%县（区）级CDC对基层医疗卫生机构开展过指导。（4）合作与参与能力：CDC与媒体开展合作的比例较高，为20.2%。（5）监测能力：县（区）级CDC开展死因监测的比例为64.6%;开展各类慢性病及危险因素监测的比例均不到30%。基层医疗卫生机构开展新发脑卒中和急性心肌梗死病例报告的比例分别为18.6%和3.0%。（6）干预与管理能力：CDC开展高血压和糖尿病患者个体化干预的比例分别为36.1%和32.2%，开展其他各类慢性病及危险因素干预的比例均不到20%。超过50%的基层医疗卫生机构开展高血压或糖尿病患者随访管理工作，但高血压和糖尿病患者管理率分别仅为12.0%和7.9%，规范管理率分别为73.8%和80.1%，控制率分别为48.7%和50.0%。（7）评估能力：13.3%的CDC或卫生行政部门对本辖区慢性病应对情况开展定期评估。（8）科研能力：省级CDC科研能力明显高于地（市）和县（区）级。结论各地慢性病预防控制政策能力偏低;县（区）级CDC慢性病预防控制能力与省和地（市）级有较大差距，亟待提高;基层医疗卫生机构开展慢性病预防控制相关工作的效果不佳。

English Abstract:

Objective To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases （NCDs） at the Centers for Disease Control and Prevention（CDCs）at all levels and grass roots health care institutions，in China. Methods On-line questionnaire survey was adopted by 3 352 CDCs at provincial，city and county levels and 1 200 grass roots health care institutions. Results 1）On policies：75.0% of the provincial governments provided special fundings for chronic disease prevention and control，whereas 19.7% city government and 11.3% county government did so. 2） Infrastructure：only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control，accounting for 4.2% of all the CDCs’personnel. 40.2% CDCs had special fundings used for NCDs prevention and control. 3）Capacity on training and guidance：among all the CDCs，96.9% at provincial level，50.3% at city level and 42.1% at county level had organized trainings on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4）Capacities regarding cooperation and participation：20.2% of the CDCs had experience in collaborating with mass media. 5）Surveillance capacity：64.6% of the CDCs at county level implemented death registration，compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions，18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6）Intervention and management capacity：36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes，while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9%,with rates on standard management as 73.8% and 80.1% and on control as 48.7% and 50.0%，respectively. 7）Capacity on Assessment：13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8）On scientific research： the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs. Conclusion Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions，both prevention and control programs on chronic diseases did not seem to be effective.

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