上海市某社区养老机构内设医疗机构及其卫生服务提供情况调查

Current situation investigation of the internal medical institutions and the providing of health services in the elderly care institutions in a community in Shanghai

目的了解上海市某社区内3家不同性质的养老机构内设医疗机构的基本情况,以及提供的卫生服务内容与机构内住养老人卫生服务需求的匹配情况,为社区卫生服务中心与养老机构合作开展医养结合服务提供决策依据。方法 2017年2—3月,采用自制问卷对上海市某社区卫生服务中心所辖区域内3家养老机构的负责人进行问卷调查。调查内容包括机构床位和入住老人情况,内设医疗机构的组织结构、人员情况和当前机构卫生服务项目开展情况。2017年9—12月,对上述3家养老机构内418名住养老人实施问卷调查。调查内容包括机构内住养老人的个人基本情况、患病情况和卫生服务需求情况。结果机构内住养老人需要的卫生服务项目主要有21项。养老机构A与机构C内设医务室,机构B内未设医疗机构。养老机构A、B、C的在职医师数分别为4、1、2人;在职护士数分别为2、1、3人;养老护理员数分别为49、32、55人,其中持初级以上职业资格证者占比分别为22.4%、62.5%和81.8%。养老机构A、B、C分别可提供卫生服务项目22、5和11项。结论养老机构内设医疗机构在医疗资源投入、医护人员的专业知识、管理能力、养老护理员服务能力等多方面存在不足。社区卫生服务中心应根据养老机构的卫生服务提供能力和机构内住养老人的卫生服务需求来调整资源配置策略,灵活采取人员派遣、技术支持、管理支撑等多种医养结合合作方式。

Objective To understand the basic conditions of the internal medical institutions,and the matching between the health service provision and demands of the elderly in three different types of elderly care institutions in a community of Shanghai,and to provide decision-making basis for the cooperation between community healthcare centers and elderly care institutions in carrying out integrated healthcare and long-term care.Methods From February to March 2017,selfdesigned questionnaires were used to conduct a survey among the people in charge of the three elderly care institutions located in the serving area of the community healthcare center.The survey investigated the number of beds and elderly people,organizational structure,staff,and health service items of the internal medical institutions.From September to December 2017,another questionnaire survey was carried out among 418 elderly people living in the three elderly care institutions.The survey covered the basic information,sickness status and health service demands of the elderly.Results There were twenty-one items of health services that the elderly demanded.There were medical rooms in the elderly care institution A and C,but no in-house clinic in institution B.The number of physicians in institution A,B and C were four,one and two,respectively.The number of nurses in institution A,B and C were two,one and three,respectively.The number of caregivers in institution A,B and C were forty-nine,thirty-two and fifty-five,respectively.The percentage of caregivers with a primary and above occupational qualification certificate in institution A,B and C were 22.4%,62.5%and 81.8%,respectively.There were twenty-two,five,and eleven health service items provided by institution A,B and C,respectively.Conclusion There are many deficiencies in the internal medical institutions in the elderly care institutions in terms of the investment of medical resources,the professional knowledge of medical staff,the management ability,and the service ability of the caregivers.The community healthcare centers are suggested adjusting the strategy of resource allocation according to the health service capacity of the elderly care institutions and the demands of elderly people living in the institutions,and adopting flexible cooperation ways such as personnel dispatch,technical support and management support to integrate healthcare and long-term care.