[Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control, in China].
[Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control, in China].
复制标题
我国慢性非传染性疾病防治规划能力评估[J].
DOI：
10.3760/cma.j.issn.0254-6450.2014.06.013
复制
发表时间：
2014
影响因子：
--
通讯作者：
Xiaoming Shi
中科院分区：
文献类型：
--
作者：
X. Si;Y. Zhai;Xiaoming Shi
目的
评估中国各级疾病预防控制中心和基层医疗机构非传染性疾病预防控制能力的政策和项目。
方法
对全国3 352个省、市、县三级疾控机构和1 200个基层医疗机构进行了在线问卷调查。
结果
1)关于政策：75.0%的省级政府为慢性病防治提供专项资金，19.7%的市级政府和11.3%的县级政府为慢性病防治提供专项资金。2)基础设施：只有7.1%的县级疾控中心报告有一个部门负责非传染性疾病的预防和控制。从事非传染性疾病防治工作的人员8 263人，占疾控机构人员总数的4.2%。40.2%的疾控机构有专项经费用于非传染性疾病防控。3)培训指导能力：所有疾病预防控制中心中，96.9%的省级、50.3%的市级和42.1%的县级疾病预防控制中心组织了非传染性疾病预防控制培训。仅有48.3%的县级疾控机构为基层医疗机构提供技术指导。4)合作和参与能力：20.2%的疾病预防控制中心有与大众媒体合作的经验。5)监测能力：64.6%的县级疾控机构开展了死亡登记工作，开展重大非传染性疾病及相关危险因素监测的县级疾控机构不足30.0%。在基层医疗机构中，有18.6%的机构实施了新的脑卒中病例报告制度，但仅有3.0%的机构实施了心肌梗死病例报告程序。6)干预和管理能力：36.1%和32.2%的疾控中心对高血压和糖尿病进行了个体化干预，对其他非传染性疾病和危险因素的干预不足20%。50%以上的基层医疗机构开展了高血压、糖尿病随访调查。高血压和糖尿病患者管理率分别为12.0%和7.9%，标准管理率分别为73.8%和80.1%，对照率分别为48.7%和50.0%。7)评估能力：13.3%的疾控中心或卫生行政部门开展了与本辖区非传染性疾病应对相关的评估项目。8)科研能力：省级疾控机构的科研能力明显高于市、县级疾控机构。
结论
需要改进非传染性疾病预防和控制政策。我们注意到，县一级和省/市级疾控中心在非传染性疾病预防和控制方面的能力存在巨大差距。在基层医疗机构，慢性病预防和控制项目似乎都没有有效。
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 funding 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 funding 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 training 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.