青海省卫生人力资源对分级诊疗实施影响分析

Status of health human resource and its influence on hierarchical medical service policy in Qinghai province

目的了解青海省卫生人力资源的现状,为青海省完善分级诊疗政策提供参考。方法 2014年9月—2015年1月在青海省2个市和6个民族自治州走访医疗机构55家(不含村卫生室和社区服务站),随机调查各医疗机构在岗的卫生人员880人。结果 880名医务人员中,20.7%为藏族,61.2%为女性;牧区医疗机构中藏族医务占牧区调查总人数的33.0%;研究生学历水平的医疗卫生人员集中在市区,基层医疗机构以本科和大专为主;各类地区和各级别医疗机构医务人员对分级诊疗制度认可度较高,达84.3%;牧区对分级诊疗制度非常认可的比例明显高于农区(χ2=11.89,P<0.01)和市区(χ2=6.01,P<0.05);30.1%的人认为该政策可以"解决大医院看病难的问题",30.5%的人认为"降低患者的医疗费用";56.3%的人认为个人专业能力对政策的落实"有一定影响",33.2%的人认为"影响很大",仅有10.5%的人认为"没有影响";农区和牧区医疗卫生人员认为当地居民不选择基层首诊的第一因素是"基层医疗设备无法得到有效利用",分别占27.7%和26.3%。结论青海省卫生人力资源不足是影响分级诊疗政策的一个重要因素,卫生人力资源水平的提升将为分级诊疗政策的落实奠定基础。

Objective To describe the status of health human resource in Qinghai province and to provide references for improvement of hierarchical medical service. Methods A face-to-face questionnaire survey was conducted among 880 medical professionals randomly selected from 55 health institutions other than village and community healthcare clinics in two municipalities and 6 ethnic autonomous prefectures in Qinghai province from September 2014 to January 2015. Results Of the 880 participants with eligible response,61. 2% were females and 20. 7% were Tibetan; 33. 0%of medical professionals working in medical institutions at pastoral areas were Tibetan. M ost of the professionals with graduate education worked in medical institutions in urban areas,whereas the majority of professionals working in grassroots institutions had university or college education. Totally 84. 3% of the respondents expressed their positive evaluation on severity-based hierarchical medical service policy; the ratio of highly positive evaluation on the policy was significantly higher among the professionals in pastoral areas than among those in agricultural areas（ χ2= 11. 89,P〈0. 01） and in urban areas（ χ2= 6. 01,P〈0. 05） and the ratio of generally positive evaluation was also significantly higher among the professionals in pastoral areas than among those in urban areas（ X2 = 5. 67,P〈0. 05）. Of all the professionals,30. 1% and30. 5% considered that the implementation of hierarchical medical service policy could solve the difficulty in visiting a doctor in large hospitals and reduce medication cost; there were 33. 2%,56. 3%,and 10. 5% of the professionals considering that individual proficiency has certain,great,and little influence on the implementation of hierarchical medical service,respectively; 27. 7% and 26. 3% of the professionals in the institutions in agricultural and pastoral areas recognized ineffective utilization of medical facilities in grassroots medical institutions as the most important factor impeding local residents to select primary medical institution for seeking medical attention initially. Conclusion Insufficient health human resource and unbalanced allocation of the resource are import factors influencing the implementation of severitybased hierarchical medical service policy in Qinghai province.