【摘要】：研究背景和目的目前國(guó)內(nèi)慢性病防控形勢(shì)嚴(yán)峻,根據(jù)《中國(guó)居民營(yíng)養(yǎng)與慢性病狀況報(bào)告(2015年)》,2012年全國(guó)居民慢性病死亡率高達(dá)533/10萬,占總死亡人數(shù)的86.6%,慢性病的疾病負(fù)擔(dān)占總疾病負(fù)擔(dān)比例超過70%,慢性病對(duì)人們的生命和財(cái)產(chǎn)安全構(gòu)成巨大威脅,它不但對(duì)患者的身心健康和生活產(chǎn)生嚴(yán)重的影響,并且由于久治不愈,給社會(huì)和患者的家庭造成沉重的負(fù)擔(dān)。不健康飲食、久坐、飲灑、吸煙等不良生活方式是許多慢性病的根源,通過規(guī)范的管理,慢性病是可防可控的,然而慢性病和慢性病的管理并沒有引起足夠的重視,多種慢性病的管理亟待提高,比如慢性蔞縮性胃炎。早在1978年世界衛(wèi)生組織就將慢性萎縮性胃炎定義為胃癌的癌前病變,胃癌在所有腫瘤中發(fā)病率和死亡率均居前列,給社會(huì)和家庭造成極大的痛苦和重?fù)?dān),然而國(guó)內(nèi)關(guān)于慢性萎縮性胃炎的管理的研究卻甚少。社區(qū)全科醫(yī)生是慢性病管理的主要承擔(dān)者,為了解社區(qū)慢性病特別是慢性萎縮性胃炎的管理現(xiàn)狀,我們分別設(shè)計(jì)了針對(duì)社區(qū)全科醫(yī)師和社區(qū)居民的調(diào)查問卷,并對(duì)社區(qū)全科醫(yī)師進(jìn)行訪談,在對(duì)問卷和訪談結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析后,根據(jù)分析結(jié)果以全科理念提出相關(guān)的建議,為社區(qū)全科醫(yī)師更好的開展慢性萎縮性胃炎管理提供參考。研究方法本論文主要運(yùn)用文獻(xiàn)法、問卷調(diào)查法和訪談法對(duì)社區(qū)慢性病和慢性萎縮性胃炎管理現(xiàn)狀進(jìn)行調(diào)查和研究。在2016年10-11月查考有關(guān)慢性病管理和慢性萎縮性胃炎的文獻(xiàn)并設(shè)計(jì)調(diào)查問卷,調(diào)查問卷分為居民版和醫(yī)師版兩部分。2016年12月-2017年2月在濟(jì)南市北村和燕山社區(qū)及社區(qū)衛(wèi)生服務(wù)中心等地發(fā)放調(diào)查問卷,并與填寫問卷的所有社區(qū)醫(yī)師進(jìn)行訪談,所有被調(diào)查者均自愿參加。共發(fā)放居民版調(diào)查問卷650份,回收有效問卷637份,回收率98.0%;醫(yī)師版調(diào)查問卷發(fā)放26份,回收有效問卷26份,回收率100%。以調(diào)查問卷為提綱,與所有填寫調(diào)查問卷的26名醫(yī)師進(jìn)行訪談。如實(shí)記錄訪談內(nèi)容,并在調(diào)查結(jié)束后進(jìn)行整理和匯總。使用Epidata3.1軟件建立數(shù)據(jù)庫(kù),采用雙人雙機(jī)重復(fù)錄入調(diào)查問卷,確保數(shù)據(jù)的準(zhǔn)確性;使用SPSS19.00統(tǒng)計(jì)分析軟件并運(yùn)用描述性統(tǒng)計(jì)(Descriptive Statistics)、卡方分析(Chi—Square Analysis)和二元 Logistic 回歸分析(Logistic Regression Analysis)等統(tǒng)計(jì)方法對(duì)數(shù)據(jù)進(jìn)行整理與分析。結(jié)果1.社區(qū)居民對(duì)慢性病及其相關(guān)知識(shí)的認(rèn)識(shí)有43.3%社區(qū)居民不了解或不太了解什么是慢性病,而86.7%的居民不了解或者不太了解慢性病管理及相關(guān)知識(shí);居民對(duì)糖尿病和高血壓的了解較多,對(duì)其他慢性病了解較少;社區(qū)居民獲得相關(guān)慢性病知識(shí)的渠道以網(wǎng)絡(luò)和媒體為主,從衛(wèi)生服務(wù)中心獲得的慢性病相關(guān)知識(shí)所占比例較低。年齡50歲、明確自己患有慢性病的居民對(duì)慢性病和慢性病管理的相關(guān)知識(shí)了解更多。2.社區(qū)居民對(duì)慢性萎縮性胃炎及其相關(guān)知識(shí)的認(rèn)識(shí)有84.9%居民不太了解或從未聽說過慢性萎縮性胃炎,對(duì)慢性萎縮性胃炎防治相關(guān)知識(shí)的知曉率更低,但居民對(duì)慢性萎縮性胃炎和胃癌的關(guān)系的認(rèn)識(shí)度卻較高;有85.6%的居民從未做過胃鏡檢查,居民對(duì)慢性萎縮性胃炎的認(rèn)識(shí)低于對(duì)慢性病總體的認(rèn)識(shí)。3.居民對(duì)社區(qū)衛(wèi)生服務(wù)中心的認(rèn)可程度及首診醫(yī)院的選擇有39.5%的居民對(duì)社區(qū)衛(wèi)生服務(wù)中心提供的醫(yī)療服務(wù)非常認(rèn)可或比較認(rèn)可,46.3%的居民認(rèn)為社區(qū)提供的醫(yī)療服務(wù)一般;僅有25.0%的居民選擇社區(qū)衛(wèi)生服務(wù)中心為首診醫(yī)療場(chǎng)所,而59.6%的居民選擇去綜合性醫(yī)院,其余15.4%選擇暫不就診�？梢娋用駥�(duì)社區(qū)衛(wèi)生服務(wù)中心的認(rèn)可度和信任度較低。4.社區(qū)全科醫(yī)師慢性病管理工作現(xiàn)狀社區(qū)全科醫(yī)師在慢性病管理中所管理的慢性病主要是糖尿病和高血壓,其它慢性病管理開展較少,全科醫(yī)生在慢性病管理中開藥占據(jù)的工作量最大,健康教育、健康檔案建立,隨訪等都有開展,但是力度不夠;57.6%的全科醫(yī)生認(rèn)為目前慢性病管理的效果不好或者一般,主要原因是工作量大,難以實(shí)施細(xì)化及個(gè)體化管理,且規(guī)范管理的慢性病種類少。有7.7%和34.6%的社區(qū)全科醫(yī)生認(rèn)為慢性病管理的效果非常好和比較好,主要原因是目前重點(diǎn)管理的慢性病已經(jīng)取得較好的效果。社區(qū)醫(yī)師認(rèn)為導(dǎo)致慢性病管理困難的原因依次是:工作量大、社會(huì)不重視、缺乏相應(yīng)政策、患者不認(rèn)可、缺乏慢性病相關(guān)培訓(xùn)。而政府政策大力支持、提高相關(guān)待遇、提高社會(huì)認(rèn)可度等有利于提高社區(qū)全科醫(yī)師慢性病管理的積極性。5.社區(qū)全科醫(yī)師對(duì)慢性萎縮性胃炎規(guī)范管理開展的建議。目前社區(qū)未開展慢性萎縮性胃炎的規(guī)范管理,原因?yàn)槁晕s性胃炎不是重點(diǎn)監(jiān)管的慢性病,社區(qū)缺乏慢性萎縮性胃炎的常用的治療設(shè)備,轉(zhuǎn)診制度不完善,全科醫(yī)師慢性萎縮性胃炎管理的知識(shí)及技能有待提高。因此開展慢性萎縮性胃炎的規(guī)范管理應(yīng)從政策支持、社區(qū)硬件建設(shè)、轉(zhuǎn)診制度完善、醫(yī)師培訓(xùn)等幾個(gè)方面努力。結(jié)論1.目前濟(jì)南市社區(qū)慢性病管理中高血壓和糖尿病管理較好,其它慢性病管理效果一般,居民特別是年輕人和非慢性病患者對(duì)慢性病的認(rèn)識(shí)和重視度不夠,居民對(duì)慢性萎縮性胃炎相關(guān)知識(shí)知曉率非常低。2.濟(jì)南市社區(qū)未開展規(guī)范的慢性萎縮性胃炎的管理,主要原因?yàn)?社區(qū)全科醫(yī)生較少,現(xiàn)有慢性病管理的工作量已經(jīng)非常大;社區(qū)缺乏慢性萎縮性胃炎的診療設(shè)備,而轉(zhuǎn)診制度又不完善;社區(qū)醫(yī)師對(duì)慢性萎縮性胃炎管理的知識(shí)不熟悉。3.要有效的開展慢性萎縮性胃炎的規(guī)范管理需要以下幾方面的共同努力:(1)相關(guān)部門政策引導(dǎo)和支持:將慢性萎縮性胃炎納入慢性病管理及醫(yī)保范疇,積極引導(dǎo)患者到社區(qū)衛(wèi)生服務(wù)中心就診。(2)社區(qū)硬件建設(shè)的提升:社區(qū)引進(jìn)消化系統(tǒng)常用的診療設(shè)備和增加常用治療藥物種類,加大預(yù)防保健和健康教育的投入和力度。(3)全科醫(yī)生慢性病管理的水平的提高:組織社區(qū)全科醫(yī)師學(xué)習(xí)慢性萎縮性胃炎防治的相關(guān)知識(shí),提高全科診療理念和慢性病管理水平。4.通過對(duì)慢性萎縮性胃炎的規(guī)范管理,可以從預(yù)防慢性萎縮性胃炎的發(fā)生,積極治療慢性萎縮性胃炎患者,規(guī)律內(nèi)鏡檢查和病理隨訪等方面來減少胃癌的發(fā)生和提高胃早癌的檢出率。
[Abstract]:Background and Objective The current situation of chronic disease prevention and control in China is grim. According to the Report on the Status of Nutrition and Chronic Diseases of Chinese Residents (2015), the mortality rate of chronic diseases in China reached 5.33/100,000 in 2012, accounting for 86.6% of the total deaths, and the burden of chronic diseases accounted for more than 70% of the total disease burden. It not only has a serious impact on the physical and mental health and life of the patients, but also imposes a heavy burden on the society and the families of the patients because of the long-term treatment. Unhealthy diet, sedentary, drinking and smoking are the root causes of many chronic diseases. Chronic diseases can be prevented and controlled by standardized management. As early as 1978, the World Health Organization (WHO) defined chronic atrophic gastritis as precancerous lesion of gastric cancer. The incidence and mortality of gastric cancer in all cancers are in the forefront, to society and families. In order to understand the management status of chronic diseases in the community, especially chronic atrophic gastritis, we designed questionnaires for community general practitioners and community residents respectively. After statistical analysis of the results of questionnaires and interviews, some suggestions were put forward based on the results of the analysis to provide reference for community general practitioners to better carry out the management of chronic atrophic gastritis. Investigation and Study on the management status of STDs and chronic atrophic gastritis. Literatures on chronic disease management and chronic atrophic gastritis were investigated and questionnaires were designed from October to November, 2016. The questionnaires were divided into residents'and doctors' editions. A total of 650 residents'questionnaires were sent out and 637 valid questionnaires were returned with a recovery rate of 98.0%. 26 doctors' questionnaires were sent out and 26 valid questionnaires were returned with a recovery rate of 100%. Twenty-six physicians were interviewed by questionnaires.The interviews were recorded truthfully and collected at the end of the survey.The database was established by using Epidata 3.1 software and the questionnaires were duplicated by two persons and two computers to ensure the accuracy of the data.SPSS19.00 statistical analysis software was used and descriptive statistics was used. Chi-Square Analysis and Logistic Regression Analysis were used to collate and analyze the data. Results 1. 43.3% of the community residents did not know or did not know what chronic diseases were, while 86.7% did not know or did not know much about them. Understanding of chronic disease management and related knowledge; Residents know more about diabetes and hypertension, less about other chronic diseases; Community residents access to relevant knowledge of chronic diseases mainly through the network and the media, the proportion of chronic disease-related knowledge from health service centers is lower. Age 50 years old, clear that they have chronic diseases. Residents know more about chronic diseases and management of chronic diseases. 2. 84.9% of the residents in the community do not know or have never heard of chronic atrophic gastritis. The awareness rate of prevention and treatment of chronic atrophic gastritis is lower, but the residents do not know about chronic atrophic gastritis and gastric cancer. 85.6% of the residents had never undergone gastroscopy, and their understanding of chronic atrophic gastritis was lower than that of the general understanding of chronic diseases. 3. The recognition of community health service centers and the choice of first-visit hospitals were highly recognized by 39.5% of the residents. 46.3% of the residents believed that the community provided general medical services; only 25.0% of the residents chose community health service centers as the first place of medical treatment; 59.6% of the residents chose to go to general hospitals; the remaining 15.4% chose not to see a doctor. Current situation of chronic disease management in community general practitioners is mainly diabetes and hypertension in chronic disease management, other chronic disease management is less carried out, general practitioners in the management of chronic diseases take up the largest workload, health education, health records, follow-up and so on, but not enough; 7.7% and 34.6% of the community general practitioners believed that the effect of chronic disease management was very good and better, mainly because of the heavy workload, difficult to implement detailed and individualized management, and the lack of standardized management of chronic diseases. Community physicians believe that the causes of chronic disease management difficulties are: heavy workload, social neglect, lack of corresponding policies, patients do not recognize, lack of chronic disease-related training. Community general practitioners'suggestions on the standardized management of chronic atrophic gastritis. Currently, there is no standardized management of chronic atrophic gastritis in the community. The reason is that chronic atrophic gastritis is not a chronic disease under the key supervision, the community lacks the commonly used treatment equipment for chronic atrophic gastritis, and the referral system is imperfect. The knowledge and skills of general practitioners in the management of chronic atrophic gastritis need to be improved. Therefore, the standardized management of chronic atrophic gastritis should be carried out from the following aspects: policy support, community hardware construction, perfect referral system, doctor training and so on. The effect of STD management is general. Residents, especially young people and non-chronic patients, do not pay enough attention to chronic diseases. Residents'awareness of chronic atrophic gastritis is very low. 2. Jinan community did not carry out standardized management of chronic atrophic gastritis. The main reasons are: fewer community general practitioners, the existing management of chronic diseases. The workload is already very large; the community lacks the chronic atrophic gastritis diagnosis and treatment equipment, and the referral system is not perfect; the community physicians are not familiar with the knowledge of chronic atrophic gastritis management. 3. To effectively carry out the standardized management of chronic atrophic gastritis requires the following joint efforts: (1) relevant departments to guide and support policy: Chronic atrophic gastritis is included in the category of chronic disease management and medical insurance, and actively guide patients to the community health service center. (2) Improvement of community hardware construction: community introduction of digestive system commonly used diagnostic and treatment equipment and increase the types of commonly used treatment drugs, increase the investment and intensity of preventive health care and health education. (3) General practitioners chronic disease management. Improvement of physical level: Organizing community general practitioners to learn the knowledge of prevention and treatment of chronic atrophic gastritis, improving the concept of general practice and management of chronic diseases. 4. Through standardized management of chronic atrophic gastritis, we can prevent the occurrence of chronic atrophic gastritis, actively treat chronic atrophic gastritis patients, regular endoscopy and regular endoscopy. Pathological follow-up and other aspects to reduce the incidence of gastric cancer and improve the detection rate of gastric cancer.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R573.32;R197.61

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7 劉啟泉;杜艷茹;劉曉輝;;慢性萎縮性胃炎治療中常見的問題及對(duì)策[A];中華中醫(yī)藥學(xué)會(huì)脾胃病分會(huì)第十九次全國(guó)脾胃病學(xué)術(shù)交流會(huì)論文匯編[C];2007年

8 李佃貴;孟憲鑫;李剛;;慢性萎縮性胃炎證治經(jīng)驗(yàn)[A];中華中醫(yī)藥學(xué)會(huì)脾胃病分會(huì)第二十次全國(guó)脾胃病學(xué)術(shù)交流會(huì)論文匯編[C];2008年

9 李佃貴;婁瑩瑩;史純純;崔建從;俞芹;;慢性萎縮性胃炎癌前病變臨床經(jīng)驗(yàn)[A];中華中醫(yī)藥學(xué)會(huì)脾胃病分會(huì)第二十次全國(guó)脾胃病學(xué)術(shù)交流會(huì)論文匯編[C];2008年

10 馬山;;再談慢性萎縮性胃炎[A];中華中醫(yī)藥學(xué)會(huì)脾胃病分會(huì)第二十次全國(guó)脾胃病學(xué)術(shù)交流會(huì)論文匯編[C];2008年

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2 郭紅梅;曾斌芳學(xué)術(shù)思想與臨床經(jīng)驗(yàn)及扶正消萎湯治療脾胃虛弱型慢性萎縮性胃炎臨床研究[D];北京中醫(yī)藥大學(xué);2016年

3 郭琳;慢性萎縮性胃炎證治規(guī)律的探討[D];南京中醫(yī)藥大學(xué);2004年

4 魏玉霞;慢性萎縮性胃炎近10年中醫(yī)文獻(xiàn)研究[D];北京中醫(yī)藥大學(xué);2012年

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6 陳國(guó)忠;周德麗教授治療慢性萎縮性胃炎學(xué)術(shù)經(jīng)驗(yàn)研究[D];廣州中醫(yī)藥大學(xué);2011年

7 韋玉娜;胃炎Ⅰ號(hào)對(duì)慢性萎縮性胃炎的治療作用及其實(shí)驗(yàn)研究[D];廣州中醫(yī)藥大學(xué);2014年

8 張倫;萎胃湯治療慢性萎縮性胃炎的臨床觀察與實(shí)驗(yàn)研究[D];廣州中醫(yī)藥大學(xué);2010年

9 杜琳;單兆偉教授慢性萎縮性胃炎證治經(jīng)驗(yàn)輯要[D];南京中醫(yī)藥大學(xué);2005年

10 鐘e，

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