基于离散选择实验的护理本科生对基层卫生工作偏好分析

Aspects Prioritized by Nursing Undergraduates During Choosing a Position in Grassroots Medical Institutions Analyzed Based on the Discrete Choice Experiment

背景分级诊疗制度是我国新医改"十三五"规划的五项重点任务之首,而基层卫生机构人员素质不高、医疗水平低下是制约分级诊疗制度有效落实的主要障碍,如何吸引和留住高素质的医护人员是推行分级诊疗制度过程中需要解决的重要问题。目的了解并分析护理本科生对基层卫生工作的偏好,提出相应的干预策略。方法基于离散选择实验,选取2017年3月在唐山市某三甲医院实习的符合纳入标准的护理本科生164人进行问卷调查。采用混合Logistic回归分析进行统计分析。结果共发放问卷164份,经逻辑纠错发现无效应答问卷11份,有效问卷153份,有效应答率为93.3%。护理本科生对基层卫生工作属性的偏好程度从大到小依次为月收入、子女就读条件、人员编制、工作地点、工作条件、职称晋升时间和系统培训机会(P<0.05)。当工作属性为:工作月收入为2 000元、在农村、无人员编制、子女就读条件较差、职称晋升时间为5年、无系统培训机会、设备和设施不完善,护理本科生中不愿意到基层卫生工作的人员比例为75%;其中假如子女就读条件得到改善,不愿意到基层卫生工作的人员比例将下降至38%。结论离散选择实验是适合分析护理本科生工作偏好的研究方法。影响护理本科生基层卫生工作意愿的因素既包括经济因素,也包括非经济因素。应针对护理本科生制定有效的政策干预包。

Background Hierarchical medical system is the top task among the five key tasks of China＇s healthcare reform during the 13th Five -Year Plan period. However, the unsatisfied qualification and professional capabilities in primary heahhcare providers have become the major obstacles in implementing the hierarchical medical system efficiently. So how to attract and retain high - quality healthcare providers is a significant issue that needs to be resolved during the implementation of the system. Objective To investigate and analyze the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions, and based on this, to propose relevant intervening measures. Methods We conducted a survey in 164 eligible nursing undergraduates who took internship in a tertiary grade A hospital in Tangshan, China with a discrete choice experiment questionnaire in March 2017. The data of the survey were analyzed with mixed - effects logistic regression models. Results Of the 164 questionnaires handed out, 153 （93.3%） were responsive, the other 11 were irresponsive assessed by logical error correction. The results of the survey showed that, the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions were as follows in the descending order： monthly income, children＇s educational conditions, staffing, working place, working conditions, time needed to get the personal promotion in professional and technical title and systematic training opportunity （P 〈0. 05 ） . When given the premises that included： monthly income of 2 000 yuan, working in rural areas, no staffing, poor educational conditions for children, 5 years needed to get the personal promotion in professional and technical title, no systematic training opportunities, inadequate equipments and facilities, 75% of the nursing undergraduates were reluctant to work at the grassroots medical institutions, but if the educational conditions for children were improved, then the percentage slumped to 38%. Conclusion Discrete selection experiment is a method suitable for analyzing the working preference of nursing undergraduates. The factors that affect nursing undergraduates＇ intentions to work in grassroots medical institutions consist of both economic and noneconomic factors. Therefore, an effective package of policy interventions should be developed aiming at this population.