全国社区卫生服务现状调查——医院服务与社区卫生服务的连续性与综合性比较

Comparative Analysis of Continuity and Comprehensiveness of Hospital Service and Community Health Service

目的比较分析社区卫生服务与医院服务的连续性和综合性的特点。方法问卷调查3省市综合医院和社区卫生服务机构的就诊患者,比较患者在不同医疗机构就诊时接受健康教育、医生对患者家庭其他成员的健康指导、每次就诊时是否找同一位医生以及社区医生是否指导患者进一步就医等情况。结果76·60%的医院就诊患者和87·34%的社区卫生服务机构就诊患者在接受医疗服务的同时,获得了健康教育服务;社区卫生服务机构对患者的健康教育活动明显高于医院;70·19%和26·10%的社区卫生服务就诊者和医院就诊者接受了医生为其家庭其他成员提供的健康指导服务;38·25%的医院就诊患者和71·95%的社区卫生服务机构就诊患者经常就诊于同一位医生;62·65%的社区卫生服务机构就诊患者接受了社区医生关于进一步就诊的指导。结论健康教育活动在社区卫生服务和医院服务中均有较广泛的开展,但健教手段、方式及方法应多样化;连续性的医学照顾是社区卫生服务的根本,应大力提倡和规范化;以家庭为中心的连续性照顾是提高社区卫生服务质量的关键,是社区卫生服务的发展方向;应加强社区医生对患者进一步就医的指导,促进双向转诊机制的建立。

[Abstract] Objective To compare and analyze the continuous and comprehensive characters of hospital service and community health service. Methods A questionnaire on patients who seek for medical care on community health service （CHS） institutions and hospitals from 3 provinces （or municipalities） was carried out. Health education, health instruction, continuity of care and situation of referral were compared. Results The ratios of patients who got health instruction were 76. 60% and 87.34% of those who went to hospitals and CHS institutions respectively; the ratios of patients＇family members who got health instruction in the two types were 26. 10% and 70. 19% respectively. There were 38.25% of the patients who went to hospitals and saw the same doctor frequently, whereas 71.95% of the patients who went to CHSI and saw the same doctor; and 62, 65% of patients who went to CHS institutions and got the instruction of seeking further medical service. Conclusion Health education has been widely carried on, however the ways and methods of it should be expanded. The continuous medical care is the foundation of CHS. Family - based continuous CHS is the key to improve the quality of CHS, and the direction of developing CHS. The instruction of further health care fro the patients should be enhanced, and the system of dual - referral should be founded.