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Problems in the management of chronic diseases
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The public's weak awareness of self health care and inadequate understanding of the hazards of chronic diseases have led to a lack of understanding of the hazards that chronic diseases will bring to people's future health, making it difficult to carry out community chronic disease prevention and control work. At present, the funds required for community chronic disease prevention and control work are entirely funded by the national government and other higher-level departments, and the annual funding for chronic disease prevention and control work is often used to manage and intervene in several major chronic diseases and factors that lead to chronic disease hazards. The lack of funding channels also makes it difficult to carry out community chronic disease prevention and control work.
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Insufficient personnel allocation and serious personnel issues have hindered the smooth implementation of chronic disease management work. There are few grassroots professionals engaged in chronic disease management, and the current situation of chronic disease management is mostly one person with multiple positions. Most staff members also take care of elderly management, resident filing, and chronic disease patient management. The shortage of personnel restricts the smooth implementation of chronic disease management work.
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The two-way referral system for chronic disease management in medical institutions at all levels is not perfect, and a good operating mechanism has not been established, resulting in unclear responsibilities for the connection between upper and lower levels of medical institutions, which affects the normal development of chronic disease management work.
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II. Countermeasures
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Strengthen health education and health promotion activities. Each community health service center should set up a bulletin board on chronic disease prevention and control knowledge, introducing the hazards and prevention measures of chronic diseases. Popularize knowledge on chronic disease prevention and control among community personnel, distribute promotional manuals, and focus on introducing the hazards and prevention measures of chronic diseases. And establish consultation points in the community to answer patients' concerns about the prevention, control, and prevention of chronic diseases, regularly hold lectures on chronic disease knowledge, and promote good habits and healthy lifestyles.
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Establish a sound referral system for upper and lower level hospitals, including a sound referral system for upper and lower level designated hospitals, and establish a dedicated institution responsible for connecting higher-level medical institutions with community health service centers for two-way referral. At the same time, standardize management, establish a systematic referral procedure, achieve practicality, and form a good operating mechanism.
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To do a good job in skill training, the first step is to provide training on the establishment of chronic disease management processes and work ideas for public health personnel, strengthen the skill training for basic work such as diagnosis, treatment, and follow-up of chronic diseases for public health personnel and clinical personnel, and have superior and experienced medical institutions provide training for lower level medical institution personnel.
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Establish a screening mechanism for upper and lower level medical institutions to screen the development of blood pressure and blood sugar measurements for first-time patients aged 35 and above, improve the authenticity of chronic disease screening, and properly register high-risk groups with information and data based on the case situation of outpatient and inpatient screening, and carry out follow-up work.
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