珠江三角洲六城市社区卫生服务中心3年门诊量及影响因素调查

Investigation of Three Years Outpatient Volume and Influencing Factors in Community Health Centers in Six Cities in Pearl River Delta

目的了解珠江三角洲六城市3种不同举办模式下社区卫生服务中心的门诊量变化及影响因素.方法采用深入访谈、自填式机构问卷、查阅政府资料及网站相结合的三角测量法,用描述性统计方法、线性回归、相关分析对定量资料进行分析,主题框架法对定性资料分析.结果 2008年至2009年,医院办、私人办和政府办社区卫生服务中心年平均门诊量增长率分别为16.76%、42.36%、422.75%;2009年至2010年分别是11.99%、52.05%、58.55%;2008年至2010年社区中心门诊量可能不受门诊次均费用(P>0.05)、举办模式(P>0.05)影响;2010年社区中心门诊量可能与社区中心大中专学历人数(P<0.01)、医生总数(P<0.05)有关;首诊入社区报销比例提高的政策使社区中心的平均门诊量得到增长数年据不同前从2008年至2010年间得到的增长.结论政府办模式对社区中心门诊量增长有促进作用,医疗保险政策有助于提高社区中心门诊量,社区中心的首诊地位已经逐步确定.

Objectives To know the changing situation of outpatient volume(OV)and influencing factors in community health centers(CHC)of three models in six cities in Pearl River Delta(PRD).Methods Triangulation method involves in-depth interview,self-reported structure questionnaire and government documents and webs review.Qualitative data was analyzed by thematic framework,and quantitative data was analyzed by descriptive statistical method,regression and correlation.Results The average increasing rate of OV in three models CHC from 2008 to 2010 were 16.76%,42.36% and 422.75%,respectively,and from 2009 to 2010年were 11.99%,52.05%,and 58.55%,respectively.The OV in CHC from 2008 to 2010 may not be influenced by average charge at the outpatient(P>0.09),fund type(P>0.05);The OV in CHC of 2010 may be influenced by the number of college-educated employees in CHC(P<0.01),the number of doctors(P<0.01).The policy of improving reimbursement ratio for those who first contacted CHC if sick has developed outpatient volume during three years.Majority patient interviewees demonstrated that CHC has been confirmed by residents.Conclusions The government-funded CHC has advantages on OV increase.HI policy can lead a positive role for CHC development.The role of CHC at first contacting has gradually been confirmed.