分层互补适宜卫生技术在基层医疗服务机构中的推广现状研究

Promotion of Stratified Complementary Appropriate Health Technology in Grass-root Health Service Settings

目的了解分层互补适宜卫生技术在基层医疗服务机构中的推广现状。方法于2013年12月在基层医疗服务机构中选取管理者和相关科室临床医生14名。采用个人深入访谈法进行资料收集,采用主题框架分析法进行资料整理。结果县级医院中,经过培训的医生基本掌握了适宜卫生技术,且大部分适宜卫生技术得到了应用;大部分乡镇卫生院中,真正将适宜卫生技术应用到临床实践中的医生较少,院内的适宜卫生技术推广工作开展欠佳。分层互补适宜卫生技术在基层医疗服务机构中开展的影响因素较多,主要为:组织管理因素,表现在技术推广制度有待健全、管理者的重视程度不够、宣传工作不到位;环境因素,表现在医院学习氛围不高、硬件设备不完善;医生因素,表现在技术掌握不佳、缺乏学习新技术动力、难以改变固有临床思维;患者因素,表现在技术依从性差、对乡镇卫生院信任度较低;政策因素,表现在基本药物制度的局限性、绩效工资制度缺乏激励性、医务人员配置不足。结论适宜卫生技术在不同级别医疗服务机构中的开展现状存在差距,县级医院优于乡镇卫生院。建议积极完善技术推广工作的组织管理体系和宣传工作;提高院领导重视程度,抓好基层医疗服务机构基础设施建设;加强基层医生继续教育,提高医生学习积极性;积极发挥卫生行政部门在适宜卫生技术推广工作中的作用。

Objective To explore the current status of the promotion of stratified complementary appropriate health technology in grass- root health service settings. Methods In December 2013,we selected 14 administrators and clinical doctors of relevant departments from grass- root health service settings. Data were collected by in- depth individual interview and were analyzed by theme frame- work analysis. Results In county hospitals,trained doctors had a basic mastery of appropriate health technology,and most health technology had been applied; in most township health centers,there were only a small number of patients who literally applied appropriate health technology in clinical practice,and the promotion of appropriate health technology had not been adequately carried out. Influencing factors for the application of stratified complementary appropriate health technology were various. In the aspect of organization and management,the influencing factors were incomplete health technology promotion system,inadequate importance attached by administrators,and inadequate publicity; in the aspect of environment,the influencing factors were inertial study atmosphere in hospitals and imperfect equipment; in the aspect of doctor, the influencing factors were poor mastery of technology,lack of drive for learning new technology,and difficulty in changing inherent clinical thinking; in the aspect of patients, the influencing factors were poor compliance with technology and distrust with township health centers; in the aspect of policy,the influencing factors were limitation of essential drug system,lack of incentive by performance pay system,and insufficient allocation of health workers. Conclusion There are gaps between medical health service settings of different levels in appropriate health technology,with county hospitals superior to township health centers. We suggest that the organization system and publicity of appropriate technology promotion should be actively improved; administrators should attach more importance on it and improve the infrastructure of grass- root medical service settings; the continuing education of grass- root doctors should be strengthened,and the learning initiative of doctors should be encouraged; the role of health administrative departments should be actively played in the promotion of appropriate health technology.