组织内外环境因素对社区医务人员从医意愿的影响

The Effect of Internal and External Organizational Environment on Community HealthWorkers' Medical Intention

目的了解影响社区医务人员从医意愿的组织内外环境因素,为促进社区医务人员结构的稳定性提供参考依据和建议。方法通过分层整群抽样方法,选取武汉市、孝感市、潜江市共12个社区卫生服务中心,对其全部医务人员进行调查,获得有效样本674例。结果社区医务人员愿意从医的比例为38.73%。多因素分析结果显示,组织内环境因素中的薪酬公平程度（OR=4.50,95%CI：2.87-7.05）;组织外环境因素中的职业尊严保障程度（OR=4.26,95%CI：2.67-6.81）、卫生政策合理程度（OR=2.61,95%CI：1.51-4.51）对社区医务人员的从医意愿的影响差异有统计学意义。结论社区医务人员的从医意愿不容乐观,组织内部环境需要考虑社区医务人员的经济收入,组织外部环境需要考虑其社会地位和卫生政策的合理性,给社区医务人员提供更大的发展空间。

Objectives To investigate and analyze the factors of internal and external organizational environment that influencing the community health workersmedical intention,and to provide some basis for the structure stability of the community health workers.Methods We used stratified-cluster sampling method to choose healthcare workers at 12 community health service centers in three cities（Wuhan,Xiaogan,Qianjiang）of Hubei province.Finally,674 questionnaires were eligible for inclusion in the analysis.Results 38.73% community health workers had medical intention in this study.Multiple-factor analysis showed that three indexes had statistically significant influence on their medical intention：salary fairness for internal organizational environment（OR=4.50,95%CI：2.87-7.05）;professional dignity（OR=4.26,95%CI：2.67-6.81）and health policy（OR=2.61,95%CI：1.51-4.51）for the external organizational environment.Conclusions Community health workersmedical intention was low.Internal organizational environment need to consider the salary farness,and external organizational environment need to consider the social status and health policy so as to provide more development space for the community health workers.