上海市社区卫生服务中心中医适宜技术的开展现状及推广对策研究

Present Situation and Strategy of Popularization of Appropriate Traditional Chinese Medicine Techniques in Shanghai Primary Community Health Centers

目的探讨上海市社区卫生服务中心中医适宜技术的开展现状,进一步分析其优势、问题及相应的推广对策。方法采用立意抽样法,在上海市16个区(县)的每个区(县)抽取2～4个社区卫生服务中心,共49个社区卫生服务中心为样本。于2017年9—11月,在查阅国家和上海市中医适宜技术相关政策的基础上,采用自行设计的调查问卷进行调查,由各社区卫生服务中心负责人填写调查问卷。问卷的主要内容有:上海市社区卫生服务中心2016年中医适宜技术的开展应用情况,包括开展的项目数、该项技术可操作医师数、该项技术可操作非中医医师数量、开展该技术的科室数量、服务人次等。共发放问卷49份,回收有效问卷48份,问卷的有效回收率为98.0%。结果2016年上海市社区卫生服务中心24项中医适宜技术项目中,平均开展(8.17±4.33)项,中位服务人次为1 914.5(5 420)人次。推广率较高的项目为推拿治疗急性腰扭伤、推拿治疗落枕、电针治疗腰椎间盘突出症、"项八针"防治颈椎病、电针浅刺法治疗面瘫,均>70%;推广率较低的项目为维生素K3三阴交穴位注射治疗盆腔痛症、董氏指压法治疗婴儿吐乳症、耳背静脉针刀割刺治疗面部扁平疣,均<10%。平均操作医师人数较多的项目为电针治疗腰椎间盘突出症、"项八针"防治颈椎病,分别为3.31、2.85人;平均操作医师人数较少的项目为董氏指压法治疗婴儿吐乳症、维生素K3三阴交穴位注射治疗盆腔痛症,分别为0.02、0.08人。平均开展科室较多的项目为电针治疗腰椎间盘突出症、"项八针"防治颈椎病,分别为1.58、1.46个;平均开展科室较少的项目为维生素K3三阴交穴位注射治疗盆腔痛症、董氏指压法治疗婴儿吐乳症,均为0.02个。平均服务人次较多的项目为电针治疗腰椎间盘突出症、社区推广穴位敷贴防治慢性呼吸系统疾病,分别为1 081、727人次;维生素K3三阴交穴位注射治疗盆腔痛症、董氏指压法治疗婴儿吐乳症服务人次均为0人次。10大类95项国家十三五期间推广的中医适宜技术目前已有9大类在上海市各社区卫生服务中心开展,除外肛肠类。48个社区卫生服务中心平均开展了(13.29±9.23)项技术,中位服务人次为18 904.5(45 410.0)人次。针刺类、敷熨熏浴类项目平均操作医师数较多,分别为21.08、10.88人,中医微创类、其他类项目平均操作医师数较少,分别为0.29、1.44人。平均服务科室较多的项目为针刺类、敷熨熏浴类,分别为10.71、4.33个,平均服务科室较少的项目为中医微创类,为0.25个。结论基层中医适宜技术在上海市社区卫生服务中心的推广已获得一定成效,但各区(县)、各社区卫生服务中心的技术推广应用情况存在一定差异。建议进一步完善基层中医药适宜技术收费项目和收费标准,遴选新一批中医适宜技术,加强中医适宜技术培训工作力度,加强中医适宜技术宣传力度。

ObjectiveTo investigate the popularization of appropriate Traditional Chinese Medicine（TCM） techniques in Shanghai primary community health service centers（PCHS）,and further analyze the advantages,problems and corresponding strategy.MethodsA total of 49 PCHS were selected from 2 to 4 PCHS in each of 16 districts（couties） of Shanghai by means of purposive sampling method.Based on TCM policies in Shanghai and China,the self-designed questionnaire,including the application of appropriate TCM techniques in Shanghai PCHS in 2016,the number of projects carried out,the number of TCM doctors,the number of non-TCM doctors,departments that can operate the technique,and the number of patients served,was used for the survey during September to November 2017,and chargers of each center filled the questionnaire.A total of 49 questionnaires were issued,and 48 questionnaires were recovered,with 98.0% of recovery rate.ResultsAmong 4 appropriate TCM technique projects in Shanghai PCHS in 2016,the average number of applied project was （8.17±4.33）,the median number of service person was 1 914.5 （5 420）.Projects with higher promotion rate were massage treatment for acute lumbar sprain,massage treatment for stiff neck,electric acupuncture treatment for lumbar disc herniation,nape eight-needle therapy for prevention and treatment of cervical spondylosis,electric needle shallow puncture treatment for facial paralysis,all〉70%.Projects with low promotion rate were vitamin K3 Sanyinjiao acupoint injection for pelvic pain,epiglottis cartilage pushing for infantile vomiting,and auricular vein acupotomy treatment for facial planar wart,all 〈10%.Items operated by physicians most were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis,which were 3.31 and 2.85,respectively.Items operated by few physicians were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting,which were 0.02 and 0.08,respectively.Items operated by most departments were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis,which were 1.58 and 1.46,respectively.Items operated by few departments were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting,which were both 0.02.Items with most average service times were electroacupuncture treatment of lumbar disc herniation and the prevention and treatment of chronic respiratory diseases with acupoint application in communities,which were 1 081 and 727,respectively.Vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting had no visit.Nine out of ten categories,including 95 items in promotion of TCM techniques during the 13th Five-year Plan has been carried out in Shanghai PCHS,excluding anorectal category.Forty-eight PCHS carried out （13.29±9.23） techniques on average,with 18 904.5 （45 410.0） median service person-time.Acupuncture and compress and fumigation were used by physicians most,which were 21.08 and 10.88,respectively.The average number of operating physicians in the category of minimally invasive TCM and other items were less,with 0.29 and 1.44,respectively.Acupuncture and compress and fumigation were used the most by departments,which were 10.71 and 4.33 on average,respectively,and technique applied by few departments was minimally invasive treatment in TCM,with 0.25 on average.ConclusionShanghai PCHS has made progress in popularizing appropriate TCM techniques.However,there are differences in application among different districts（couties） and PCHS.The suggestions are to improve charging items and standards,select new TCM projects and strengthen the long-term training and publicity of appropriate TCM techniques.