以护士为主导的社区眼科诊所就医现状分析

Analysis of current status of in eye community based nurse-led clinics

目的探索以护士为主导的社区眼科诊所管理模式的优缺点。方法分析2016年3月至2018年3月青岛眼科医院社区门诊部设立2年间患者就医特点,回顾2年间门诊部人员、设备配置及调整情况。结果 2年间青岛眼科医院社区门诊部共接诊患者17 042例,65岁以上的老年患者占首位为44.9%(7 657/17 042)。眼表疾病占34.4%(5 862/17 042)、白内障占31.6%(5 382/17 042)和屈光不正占17.2%(2 928/17 042)为患者就诊主要原因的前3位。以护士为主导的诊所(NLC)患者就诊等待时间为1~114(8.5 ± 8.5)min,主院区门诊患者就诊等待时间为32.0~61.0(42.4 ± 7.1)min,差异有统计学意义(Z=-135.172,P<0.01)。NLC患者人均花费为4.0~153.2(64.9 ± 22.0)元,主院区门诊患者人均花费为110.0~586.9(291.0 ± 160.0)元,差异有统计学意义(Z=-136.531,P<0.01)。NLC在病情的咨询、就诊及时性和便利性3个项目上得分均高于主院区(Z=-7.278、-7.462、-12.677,P<0.01),在病情解决的项目上低于主院区(Z=-3.188,P<0.01)。结论 NLC模式是可以满足社区眼科诊所需求的新型管理模式,是医疗改革下对护理人员的新挑战。

Objective To explore the advantages and disadvantages of a new management model of eye community based nurse-led clinics. Methods From March 2016 to March 2018, a community clinic of a tertiary eye hospital, Qingdao Eye Hospital was analyzed. The situation of staff and equipment allocation and adjustment in the Clinic during the two years was also reviewed. Results A total of 17042 patients were admitted to the community clinic of a tertiary eye hospital in the past two years, among whom 44.9% were over 65 years old. Ocular surface diseases (34.4%, 5862), cataracts (31.6%, 5382), and refractive errors (17.2%, 2928) were the top three causes of patient visits. The waiting time for NLC patients was 1~114 (8.5±8.5) min, and the waiting time for outpatients in the main hospital area was 32.0~61.0 (42.4±7.1) min. The difference was statistically significant (Z=-135.172, P<0.01). The per capita cost of NLC patients was ￥ 4.0~153.2 (64.9±22.0), and the per capita cost of outpatients in the main hospital area was ￥ 110.0~586.9 (291.0±160.0), the difference was statistically significant (Z=-136.531, P<0.01). NLC scored higher than the main hospital area in consultation, timeliness and convenience of the disease(Z=-7.278,-7.462,-12.677, P<0.01), and was lower than the main hospital in the disease-solving project (Z=-3.188, P<0.01). Conclusion The NLC model is a new management model that can meet the needs of community clinics and also is a new challenge for nursing staff under the health care reform.