安徽省阜阳市农村乡镇卫生机构卫生服务质量现状分析

Service quality in township health institutions in Fuyang,Anhui Province

目的:通过对安徽省阜阳市农村乡镇卫生机构卫生服务质量现状调查,了解主要质量问题,为制定持续改进的绩效管理方案提供依据。方法:调查安徽省阜阳市A、B两县内所有乡镇卫生机构卫生服务质量的基础数据,包括常规统计资料收集、抽查各机构的处方、病历,卫技人员知识技能考核,调查居民满意度。结果:乡镇卫生机构门诊抗生素、静脉给药处方比例分别达56.05%和50.38%,病历书写合格率仅为23.02%,医生、护士、防保人员的三基正确率分别为60.38%、55.01%和52.33%。0～6岁儿童系统管理率、孕产妇系统管理率分别为46.06%和22.72%。结论:农村卫技人员素质不高,影响基本卫生服务提供;用药不合理和临床诊疗不规范,导致严重的医疗安全隐患;筹资与分配制度是影响基本公共卫生服务提供的重要因素。建议:优化人才引进机制,健全继续医学教育制度;加强技能培训,完善临床诊疗规范;加强绩效考核,改进经费分配制度。

Objectives： To understand problems with quality in township health institutions in Fuyang, Anhui Province, and to provide recommendations for better managing these services. Methods ： Data on health service quality at all institutions in two counties in Fuyang, Anhui Province, was collected. These data included routine statistical data, data on prescriptions, health records, and the results of surveys on health worker knowledge and skills and resident satisfaction. Results： The prescription percentages of outpatient antibiotics and intravenous administration were 56. 05% and 50. 38% in township health institutions, respectively. The proportion of qualified medical records was 23.02%. The accurate rates of examination on the basic theory, knowledge and skills of doctors, nurses and health- care personnel were 60. 38%, 55.01% and 52.33%, respectively. Maternal and child system management rates were 22. 72% and 46. 06%, respectively. Conclusion ： The quality of health personnel in the surveyed township was not high, and impacted basic health service delivery. Drug use and clinical diagnosis and treatment were not standardized, and this was leading to serious potential safety hazards. Financing and distribution systems were important factors influencing the basic public health services delivery. Recommendation： The talent introduction mechanism and continuing medical education system should be optimized. Training in clinical diagnosis and treatment standards should be improved. Performance assessment should also be improved, and the funding allocation system should be ameliorated .