慢病随访管理系统：慢病随访的内容是什么？

　　慢病随访服务指对辖区内患有高血压、糖尿病等慢性病的患者提供一般体格检查，包括血压、心率、脉率及血糖检测等，同时通过了解患者服药情况以及吸烟、饮酒、运动和饮食情况，指导帮助患者合理用药、合理饮食、适量运动，以正确健康的生活方式，积极乐观的心态，预防糖尿病、高血压并发症的发生，并向群众宣传基本公共卫生服务项目内容，让群众更加深入了解基本公共卫生服务的惠民政策。

Follow up service for chronic diseases refers to providing general physical examination for patients with hypertension, diabetes and other chronic diseases within the jurisdiction, including blood pressure, heart rate, pulse rate and blood sugar detection. At the same time, through understanding the patients' medication, smoking, drinking, exercise and diet, guiding and helping patients to use drugs, eat properly, exercise moderately, prevent the occurrence of diabetes and hypertension complications with a correct and healthy lifestyle, a positive and optimistic attitude, and publicize the contents of the national basic public health service project to the masses, so that the masses can have a deeper understanding of the national basic public health service policies for the benefit of the people.

　　慢病随访管理系统进一步落实公共卫生服务的慢性病管理工作，提升辖区慢病规范化管理的服务质量，及时掌控慢性病患者的病情，给予居民指导普及慢病防治知识。

The chronic disease follow-up management system further implements the chronic disease management work of national public health services, improves the service quality of standardized management of chronic diseases in the jurisdiction, timely controls the condition of chronic disease patients, and provides guidance and popularization of chronic disease prevention and control knowledge to residents.

　　通过开展随访工作，使越来越多的居民掌握高血压和糖尿病等慢性病的防控知识，减少高血压、糖尿病等慢性病并发症的发生。

Through follow-up work, more and more residents will master the knowledge of prevention and control of chronic diseases such as hypertension and diabetes, and reduce the occurrence of chronic disease complications such as hypertension and diabetes.

　　医护人员“，心贴心”的服务赢得了患者的认可与信赖，并且提高了慢性病人群参加定期随访查体的积极性和主动性。

The "zero distance, caring" service provided by medical staff has won the recognition and trust of patients, and has increased the enthusiasm and initiative of chronic patients to participate in regular follow-up and physical examinations.

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