An analysis of the driving forces and resistance in the implementation of the "Integrated Control and Prevention of Three Highs and Six Diseases" strategy for chronic disease management in Shandong province

The "Integrated Control and Prevention of Three Highs (high blood pressure/glucose/lipids) and Six Diseases (coronary heart disease, stroke, renal lesions, retinal lesions, peripheral neuropathy, and peripheral vascular lesions)" strategy is an important measure to establish and improve the integrated management service system for medical treatment and prevention of chronic diseases in Shandong province. This study uses stakeholder theory to define the stakeholders of the "Integrated Control and Prevention of Three Highs and Six Diseases" strategy, to explore the different stakeholder interests such as health care demand, supply, management and financing, and to analyze the losses and benefits of each stakeholder. From a stakeholder perspective, this study examines the drivers and barriers to implementing the integrated control and prevention of three highs and six diseases strategy. It finds that the political imperatives of health administrations and the needs of the population for quality and affordable health services are the main drivers of strategy implementation. The main obstacles to implementing the strategy are patients' own medical concepts, increased workload for medical staff in primary health care facilities, and reduced revenues for general hospitals. Based on the analysis, we propose some performance coordination measures for the "Integrated Control and Prevention of Three Highs and Six Diseases" strategy, including changing residents' inherent medical concepts through publicity and education, increasing investment in grassroots medical and health institutions and improving their health service levels, and improving incentive policies for medical personnel, in order to promote and ensure the implementation and development of the chronic disease management strategy.