School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Social Development and Public Policy, Fudan University, Shanghai, China.
Int J Health Plann Manage. 2019 Jul;34(3):935-946. doi: 10.1002/hpm.2865. Epub 2019 Aug 1.
Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management-self-management-has been developed in community health service centres (CHSCs).
To clarify how contracting with CHSC-based family doctors (FDs) influences the engagement in and effectiveness of self-management behaviour among NCD patients.
We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self-management and the effectiveness of this self-management.
Nearly all contracted patients (80.79%) had implemented NCD self-management, while only 55.57% of non-contracted patients did so. The self-management effectiveness rate was also higher among contracted patients than among non-contracted ones (86.66% vs. 54.79%). In the population-averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self-management and reporting that the self-management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD-contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self-management.
FDs were important for ensuring that NCD patients engaged in self-management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self-management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self-monitoring. Self-management might help to achieve greater NCD control.
非传染性疾病（NCDs）是全球人口健康的主要威胁。在中国上海，社区卫生服务中心（CHSCs）开发了一种新的 NCD 管理模式——自我管理。
阐明与 CHSC 基础家庭医生（FDs）签约如何影响 NCD 患者参与和实施自我管理行为的效果。
我们进行了两次问卷调查（2013 年和 2016 年），以收集 NCD 患者的数据。分别使用逻辑回归模型和纵向分析来检验与 FD 签约对 NCD 自我管理的影响，以及这种自我管理的效果。
几乎所有签约患者（80.79%）都实施了 NCD 自我管理，而只有 55.57%的非签约患者这样做。签约患者的自我管理效果率也高于非签约患者（86.66%比 54.79%）。在人群平均模型中，在控制所有相关变量后，签约患者实施自我管理和报告自我管理有效的可能性分别是未签约患者的 2.25 倍和 2.91 倍。此外，对 FD 签约服务的认识、对 CHSCs 的满意度和在 CHSCs 的首次接触对自我管理的实施和效果有积极影响。
FDs 对确保 NCD 患者参与自我管理行为很重要，最常见的形式是焦点小组。参与 NCD 焦点小组可能是实现自我管理效果的关键，包括提高健康知识、增强健康意识、更频繁地参与健康行为，最重要的是，更频繁地进行自我监测。自我管理可能有助于更好地控制 NCD。
