2012和2015年中国8省基层医务人员慢性病管理工作情况
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摘要
目的了解参与国家基本公共卫生服务慢性病患者(高血压和糖尿病)管理项目的基层医务人员工作现状,为基层慢性病管理提供政策依据。方法于2012、2015年对全国8个省(自治区)的48个基层医疗卫生机构的医务人员进行面对面问卷调查。调查内容包括基本情况、管理人数、服务内容、培训情况、工作负荷和主要困难(仅2015年调查此项)。使用SAS 9.4软件进行χ~2检验、Wilcoxon秩和检验。结果 2012和2015年分别调查406和757名基层医务人员。其中兼职人员比例从2012年的62.72%上升至2015年的70.56%,差异有统计学意义(χ~2=7.42,P<0.01)。指导患者用药的比例从2012年的65.76%提高到了2015年的84.41%,差异有统计学意义(χ~2=53.39,P<0.01)。2015年96.83%(733人)基层医务人员接受过慢性病管理相关培训,包括生活方式指导、心理辅导、药物治疗和慢性病自我管理等,高于2012年的91.87%(373人),差异有统计学意义(χ~2=13.94,P<0.01)。2015年33.24%的调查对象希望参与国家基本公共卫生服务规范培训,但仅有6.54%的调查对象希望参加生活方式指导技能方面的培训。2015年调查对象认为最多可以管理的慢性病患者例数(中位数)为100例,低于2012年的143例。2015年74.37%的基层医务人员超负荷工作,高于2012年的62.58%,差异有统计学意义(χ~2=14.44,P<0.01)。2015年有39.58%和36.52%的基层医务人员认为患者依从性不高和基层药物不能满足患者需求是其所面临的主要困难。结论基层医疗机构开展慢性病管理指导内容的所有管理人员比例和接受培训的所有管理人员比例均有所增加,但基层医务人员面临超负荷工作、患者依从性不高和基层药物不足等问题。应合理配置医疗卫生资源,提高卫生服务可及性和应答性,并加快提高基层医务人员的专业能力。
Objective To understand the working status of medical staff in primary institutions for patients with non-communicable diseases(hypertension and diabetes) management of national primary public health service and to provide the basis for further policy on non-communicable diseases prevention and control. Methods In 2012 and 2015,a questionnaire investigation among medical staff was performed in forty-eight primary healthcare institutions of eight provinces or autonomous region in China. The questionnaire included the basic information,management status,service content,training,workload and difficulties(only in2015). Chi square test and Wilcoxon rank sum test were performed with SAS 9.4 software. Results In 2012 and 2015,406 and757 medical staff were investigated,respectively. The percentage of part-time staff increased from 62.72% in 2012 to 70.56% in2015(χ~2=7.42,P<0.01). The percentage of directing the patients increased from 65.76% in 2012 to 84.41% in 2015(χ~2=53.39,P<0.01). In 2015,96.83%(733) of medical staff received the non-communicable diseases management training(the lifestyle,psychological counselling,medication and non-communicable disease self-management),which was significantly higher than that(91.87%,373) in 2012(P<0.01). In 2015,33.24% of subjects wished to take part in the national primary public health services training,but only 6.54% of subjects wished to take part in healthy lifestyle training. In 2015,the median of managed subjects at most was 100,which was lower than that(143) in 2012. In 2015,the percentage of medical staff in primary institutions with overwork status was 74.37%,which was significantly higher than that(62.58%) in 2012(χ~2=14.44,P<0.01). In 2015,39.58% and 36.52% of medical staff in primary institutions considered two kinds of difficulty,i.e. the low patient compliance and insufficient medications in primary institutions. Conclusion The percentages of all medical staff conducting the services and receiving the training in primary institutions increased,but there were some main problems,i.e. overwork,the low patient compliance and insufficient medications in primary institutions. It should be allocated the medical resources rationally,increased the availability and responsiveness of health service,and enhance the professional ability staff.
Objective To understand the working status of medical staff in primary institutions for patients with non-communicable diseases(hypertension and diabetes) management of national primary public health service and to provide the basis for further policy on non-communicable diseases prevention and control. Methods In 2012 and 2015,a questionnaire investigation among medical staff was performed in forty-eight primary healthcare institutions of eight provinces or autonomous region in China. The questionnaire included the basic information,management status,service content,training,workload and difficulties(only in2015). Chi square test and Wilcoxon rank sum test were performed with SAS 9.4 software. Results In 2012 and 2015,406 and757 medical staff were investigated,respectively. The percentage of part-time staff increased from 62.72% in 2012 to 70.56% in2015(χ~2=7.42,P<0.01). The percentage of directing the patients increased from 65.76% in 2012 to 84.41% in 2015(χ~2=53.39,P<0.01). In 2015,96.83%(733) of medical staff received the non-communicable diseases management training(the lifestyle,psychological counselling,medication and non-communicable disease self-management),which was significantly higher than that(91.87%,373) in 2012(P<0.01). In 2015,33.24% of subjects wished to take part in the national primary public health services training,but only 6.54% of subjects wished to take part in healthy lifestyle training. In 2015,the median of managed subjects at most was 100,which was lower than that(143) in 2012. In 2015,the percentage of medical staff in primary institutions with overwork status was 74.37%,which was significantly higher than that(62.58%) in 2012(χ~2=14.44,P<0.01). In 2015,39.58% and 36.52% of medical staff in primary institutions considered two kinds of difficulty,i.e. the low patient compliance and insufficient medications in primary institutions. Conclusion The percentages of all medical staff conducting the services and receiving the training in primary institutions increased,but there were some main problems,i.e. overwork,the low patient compliance and insufficient medications in primary institutions. It should be allocated the medical resources rationally,increased the availability and responsiveness of health service,and enhance the professional ability staff.
引文
[1]司向,尹香君,施小明.全国疾控系统慢性病预防控制人力资源现状分析[J].中华疾病控制杂志,2010,14(9):892-895.
[2]王园.乡镇卫生院疾控岗位绩效考核现状研究[D].北京:中国疾病预防控制中心硕士论文集,2013:1-54.
[3]王帅.我国基层卫生人力资源现状研究及政策建议[D].北京:首都医科大学硕士论文集,2016:1-89.
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[5]荆丽梅.我国乡镇卫生院和城市社区卫生服务机构人力资源管理现状调查[D].山东:山东大学硕士论文集,2008:1-89.
[6]王帅,蔡敏,徐玲,等.我国基层医务人员离职意向状况与分析[J].中国卫生信息管理,2016,13(2):206-213.
[7]孟向京,姜凯迪.城镇化和乡城转移对未来中国城乡人口年龄结构的影响[J].人口研究,2018,42(2):39-53.
[8]李园,任多富,丁萍飞,等.中国8省(自治区)高血压和2型糖尿病患者健康管理服务实施现状[J].中华流行病学杂志,2014,35(1):35-39.
[9]徐望红,张勇,王继伟,等.中日两国慢性病防控策略比较及政策启示[J].中国慢性病预防与控制,2016,24(8):593-596.
[10]王宏伟,李洪玉.上海市奉贤区老年高血压病人服药依从性的影响因素分析[J].中西医结合心脑血管杂志,2018,16(9):1236-1238.
[11]李艳.高血压患者药物治疗依从性调查及护理对策分析[J].中国慢性病预防与控制,2017,25(12):893-897.
[12]何梅,肖琦,黄素芳,等.药物依从性治疗的研究进展[J].医学与社会,2018,31(6):58-61.
[13]茅雯辉,张露莹,陈文,等.我国基层医疗机构基本药物配备使用现况分析[J].中国卫生资源,2013,16(2):95-97.
[14]罗庆,刘欢,刘军安,等.我国基层医疗机构基本药物制度实施情况及问题分析[J].管理改革评论,2016,37(11A):64-67.
[15]中华人民共和国中央人民政府.国家基本药物目录品种又有增加[EB/OL].[2018-09-15].http://www.gov.cn/xinwen/2018-09/06/content_5319631.htm.
[16]Liu Y,Yang G,Zeng Y,et al.Policy dialogue on China’s changing burden of disease[J].Lancet,2013,381(9882):1961-1962.
[17]国家卫生和计划生育委员会.2016年中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2017:177.
[18]陈育德.重温《阿拉木图宣言》推进健康中国建设[J].中华预防医学杂志,2018,52(5):457-459.
[2]王园.乡镇卫生院疾控岗位绩效考核现状研究[D].北京:中国疾病预防控制中心硕士论文集,2013:1-54.
[3]王帅.我国基层卫生人力资源现状研究及政策建议[D].北京:首都医科大学硕士论文集,2016:1-89.
[4]国务院.国务院关于印发“十三五”卫生与健康规划的通知[EB/OL].[2018-09-23].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.
[5]荆丽梅.我国乡镇卫生院和城市社区卫生服务机构人力资源管理现状调查[D].山东:山东大学硕士论文集,2008:1-89.
[6]王帅,蔡敏,徐玲,等.我国基层医务人员离职意向状况与分析[J].中国卫生信息管理,2016,13(2):206-213.
[7]孟向京,姜凯迪.城镇化和乡城转移对未来中国城乡人口年龄结构的影响[J].人口研究,2018,42(2):39-53.
[8]李园,任多富,丁萍飞,等.中国8省(自治区)高血压和2型糖尿病患者健康管理服务实施现状[J].中华流行病学杂志,2014,35(1):35-39.
[9]徐望红,张勇,王继伟,等.中日两国慢性病防控策略比较及政策启示[J].中国慢性病预防与控制,2016,24(8):593-596.
[10]王宏伟,李洪玉.上海市奉贤区老年高血压病人服药依从性的影响因素分析[J].中西医结合心脑血管杂志,2018,16(9):1236-1238.
[11]李艳.高血压患者药物治疗依从性调查及护理对策分析[J].中国慢性病预防与控制,2017,25(12):893-897.
[12]何梅,肖琦,黄素芳,等.药物依从性治疗的研究进展[J].医学与社会,2018,31(6):58-61.
[13]茅雯辉,张露莹,陈文,等.我国基层医疗机构基本药物配备使用现况分析[J].中国卫生资源,2013,16(2):95-97.
[14]罗庆,刘欢,刘军安,等.我国基层医疗机构基本药物制度实施情况及问题分析[J].管理改革评论,2016,37(11A):64-67.
[15]中华人民共和国中央人民政府.国家基本药物目录品种又有增加[EB/OL].[2018-09-15].http://www.gov.cn/xinwen/2018-09/06/content_5319631.htm.
[16]Liu Y,Yang G,Zeng Y,et al.Policy dialogue on China’s changing burden of disease[J].Lancet,2013,381(9882):1961-1962.
[17]国家卫生和计划生育委员会.2016年中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2017:177.
[18]陈育德.重温《阿拉木图宣言》推进健康中国建设[J].中华预防医学杂志,2018,52(5):457-459.
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