基层卫生综合改革重点联系区县基层医务人员职业满意度研究

Occupational Satisfaction in Primary Care Providers in Highly Focused Districts/Counties during the Comprehensive Reform of Primary Care System in China

目的了解2014—2016年基层卫生综合改革重点联系区县(重点联系区县)基层医务人员的职业满意度。方法于2014年在17个省34个重点联系区县中随机抽取102个基层医疗卫生机构,2014—2016年均以该102个基层医疗卫生机构调查当天的所有在岗医务人员为研究对象,纳入医务人员数分别为3 171、3 470、3 198例。采用国家卫生计生委卫生发展研究中心设计的问卷,对纳入基层医务人员进行调查,主要内容包括基层医务人员的基本情况、工作量和薪酬、执业环境、人事分配情况及职业满意度。结果 2015、2016年基层医务人员日均工作时间>8 h者所占比例低于2014年,2016年基层医务人员对薪酬和付出的关系评价优于2014、2015年,差异有统计学意义(P<0.017)。2016年基层医务人员认为得到患者尊重者所占比例高于2014年,2015、2016年基层医务人员认为得到社会尊重者所占比例高于2014年,差异有统计学意义(P<0.017)。2016年基层医务人员有职务晋升者所占比例高于2015年,有职称晋升者所占比例高于2014、2015年,差异有统计学意义(P<0.017)。2016年基层医务人员的总体满意率为79.8%(2 552/3 198),高于2014、2015年,差异有统计学意义(P<0.017)。其中,2016年基层医务人员对工资收入、绩效考核、执业环境、办公环境、设备设置、职务晋升的满意率高于2014年,对工资收入、绩效考核、执业环境、办公环境的满意率高于2015年,差异有统计学意义(P<0.017)。结论基层医务人员执业环境改善,社会地位提升;部分重点联系区县完善了基层医务人员薪酬分配制度,收入满意率有所提升。完善基层医疗卫生机构激励机制,拓展职业发展前景是吸引和留住基层卫生人才根本之策,也是提升基层能力的关键。

Objective To investigate the occupational satisfaction in primary care providers(PCPs)in highly focused districts/counties from 2014 to 2016 during the comprehensive reform of primary care system in China.Methods From the 34 highly focused districts/counties in 17 provinces during the comprehensive reform of primary care system,we randomly selected 102 grassroots medical institutions in 2014,and enrolled all the PCPs who were on duty in these institutions on the survey day in 2014(3 171 cases),2015(3 470 cases),2016(3 198 cases),respectively.All of them were surveyed by a questionnaire developed by the China National Health Development Research Center consisting of demographic data,workload and salary,status of gaining respect from patients and the society,promotion in position and professional and technical title and occupational satisfaction.Results The percentage of PCPs with daily working hours exceeding 8 hours in 2014 was higher than that of 2015 or 2016(P<0.017).The assessment of salary based on workload by the PCPs in 2016 was much better than that of 2014 or 2015(P<0.017).The percentage of PCPs thinking that they should be respected by patients in 2016 was higher than that of 2014(P<0.017).Moreover,the percentage of PCPs thinking that they should be respected by the society increased obviously in 2015,2016,respectively compared with 2014(P<0.017).Higher proportion of PCPs achieved promotion in position in 2016 compared with 2015(P<0.017),and the portion of PCPs achieving promotion in professional and technical title in 2016 was higher compared with 2014 and 2015(P<0.017).The overall level of satisfaction in PCPs in 2016 was 79.8%(2 552/3 198),which was much higher than that of 2014 or 2015(P<0.017),specifically,their levels of satisfaction with salary,results of performance appraisal,status of gaining respect from patients and the society,working environment,equipment configuration and promotion in position increased significantly compared with 2014(P<0.017),and their levels of satisfaction with salary,results of performance appraisal,status of gaining respect from patients and the society and working environment increased notably compared with 2015(P<0.017).Conclusion In these highly focused districts/counties,the PCPs'social status has been improved along with the increase of the level of respect gained from patients and the society.Some of these districts/counties have improved the salary allotment system,which leads to increased level of satisfaction with salary in the local PCPs.In view of this,improving the incentive mechanisms and enhancing the career and professional development are the key methods for grassroots medical institutions to attract and retain medical talents and advance their service capabilities.