乡镇卫生院管理人员卫生改革政策满意度评价

Evaluations on health reform policies among administrative staff in township health centers

目的了解贵州省乡镇卫生院管理人员对当前中国卫生改革政策的评价状况,为寻找束缚农村基层卫生改革政策执行的主要障碍提供思路。方法于2017年7月采用典型抽样方法选取贵州省乡镇卫生院管理人员开展卫生改革政策的熟悉状况及满意度调查,分析卫生改革政策满意度的影响因素。结果共调查1 285名对象,其对当前主要卫生改革政策了解的比例为77.0%~93.5%,从不同角度评价卫生改革政策满意的比例为59.3%~66.9%;卫生政策满意度与各项卫生改革政策熟悉程度之间呈正相关(P <0.01);年龄越大(> 50岁:OR=9.328;40~49岁:OR=4.632; 30~39岁:OR=4.759)、工作年限≥10年(OR=1.946)、职称等级越高(高级职称:OR=3.117;中级:OR=2.804;初级:OR=1.900)、医改政策的熟悉程度越低(不熟悉组:OR=11.090;基本熟悉:OR=4.297)、关注度越少(不关注组:OR=2.936;偶尔关注:OR=2.460)的对象不满意评价的倾向越高,其OR值均> 1(P <0.01)。结论乡镇卫生院管理人员对卫生改革政策的了解程度尚可,但满意度不高;年龄、工作年限、职称、卫生改革政策的熟悉和关注是卫生政策满意度的影响因素;应加强卫生改革政策的认同培养,并加大队伍建设和经费的政策支持力度。

Objective To examine the status and influencing factors of satisfaction to health reform policies among administrative staff in township health centers for exploring main obstacles to the implementation of health reform policies at grassroots level in rural areas. Methods We conducted a survey among 1 445 main or charged administrators selected from all township health centers across Guihzou province （one respondent for each center） with v/pica/sampling in July 2017. Information about cognition on and satisfaction to health reform policies were collected with a self-administered questionnaire among the respondents. Results Of the 1 285 eligible responders, 77.0% to 93.5% reported the understanding on main health reform policy domains and 59.3% to 66.9% reported the satisfaction to the implementations of the domains, with a significant positive correlation between the satisfaction and the understanding （P 〈 0.01）. The results of multivariate ordered category logistic regression analysis demonstrated that the responders at elder age （ ≥ 50 years： odds ratio [OR] = 9.328, 95% confidence interval [95% CI]： 3.868 - 22.482）, with a working duration of ≥ 10 years （OR = 1.946, 95% CI： 1.353 - 2.799）, with a senior professional title （OR = 3.117, 95% CI： 1.342 - 7.236）, having less understanding on the policies （OR = 11.090, 95% CI： 6.406 - 19.198）, and paying less attention to the policies （OR = 2.936, 95% CI： 1.746 - 4.941） were more likely to be unsatisfactory to the policies. Conclusion The managers of township hospitals have a better understanding on but a lower satisfaction to the rural health reform policies and the satisfaction is mainly influenced by the manages＇ age, working years, professional title, understanding and concerns on the policies. The results suggest that relevant efforts should be taken to promote the implementation of health reform policies in rural areas.