广州市出生缺陷防治连续性服务主要影响因素研究

Study on the major influence factor of continuous service for prevention and control of birth defects in Guangzhou

目的探讨广州市的出生缺陷防治服务的连续性程度及其对出生缺陷防治效果的影响。方法随机抽取广州市4个区,对区卫生和计划生育局(区卫计局)的分管领导、3家三级医疗保健机构和2家二级医疗保健机构及就诊患者进行现场问卷调查。结果 66. 67%医疗服务提供方所在的单位能与其他医疗机构共享患者的婚前、孕前、产前咨询和检查信息;76. 82%医疗服务提供方认为所在科室的接诊效率为"高"。产前筛查情况、完成孕前及孕早期叶酸预防神经管缺陷项目比例、婚前、孕前、产前咨询和检查信息在机构间传递的完整性、检查互认的落实度对医疗卫生信息的传递的连续的影响分别居前三位。针对出生缺陷防治连续性服务进行监管的措施,以及建立并实施上下级医院双向转诊;针对双向转诊制度建立管理评价指标体系、出生缺陷医疗服务链管理评价指标体系的单位均占71. 42%;被调查医疗服务管理方所在单位的人员对提供连续性服务的认可度比较认可态度占57. 14%;42. 86%被调查医疗服务管理方所在单位对于经济困难家庭进行一定的补助。结论医疗服务提供方对出生缺陷防治连续性服务的影响因素主要为:医疗机构是否共享患者的婚前、孕前、产前咨询和检查信息,以及科室接诊率的高低。医疗服务需求方对出生缺陷防治连续性服务的影响因素分为两方面,一是医疗卫生信息传递的连续的影响,影响因素分别是产前筛查情况、完成孕前及孕早期叶酸预防神经管缺陷项目比例、婚前、孕前、产前咨询和检查信息在机构间传递的完整性、检查互认的落实度;二是对卫生服务提供与利用的连续的影响。影响因素分别是医从性的高低、就诊的便利性、医疗护理、预防保健和康复医疗的过程连续性服务。医疗服务管理方对出生缺陷防治连续性服务的影响因素主要为:对双向转诊制度是否建立管理评价指标体系、出生缺陷医疗服务链管理评价指标体系以及对于经济困难家庭是否进行一定的补助。

Objective To explore the degree of continuity of birth defect prevention service and its influence on the effect of birth defect prevention in Guangzhou.Methods Four sample districts of Guangzhou were randomly selected to conduct an field questionnaire survey on the leaders in charge of the district health and family planning bureau,3 tertiary health care institutions and 2 secondary health care institutions and the patients in these institutions.Results 66.67%of the medical service providers can share the patient information of pre-marital,pre-pregnancy,prenatal consultation and examination with other medical institutions.76.82%of medical service providers believed that the clinical reception efficiency was high.Prenatal screening status,proportion of projects completed before and during the first trimester of pregnancy for folic acid prevention of neural tube defects,integrity of information transfer between institutions on pre-marital,pre-pregnancy,prenatal consultation and examination,mutual recognition on the medical examination results were ranked in the top three factors of the continuity of medical and health information transmission respectively.71.42%of the medical institutions took measures on the supervision on the continuous service of birth defect prevention and control,as well as implementation of two-way referral.Management evaluation index system on two-way referral system and evaluation index system of birth defect medical service chain management were established in 71.42%of the medical institutions.57.14%of the staff had a relatively favorable attitude towards providing continuous services provision.42.86%of the medical institutions provided certain subsidies to the families with financial difficulties.Conclusions Sharing the patient information of pre?marital,pre?pregnancy,prenatal consultation and examination and the rate of clinical reception were the main influencing factors on the continuous service of birth defect prevention.The influencing factors on the continuous service of birth defect prevention could be divided into two aspects.One was the continuous impact on the medical and health information transmission,with the influencing factors of prenatal screening status proportion of projects completed before and during the first trimester of pregnancy for folic acid prevention of neural tube defects,integrity of information transfer between institutions on pre-marital,pre-pregnancy,prenatal consultation and examination,mutual recognition on the medical examination results.The other one was the continuous impact on health service delivery and utilization,with the influencing factors of patient compliance,convenience of visiting doctors,continuous services of the medical care,preventive health care and rehabilitation.Establishing of management evaluation index system on two-way referral system and evaluation index system of birth defect medical service chain management,as well as provision of certain subsidies to the families with financial difficulties were considered the influencing factors of medical service management on continuous service of birth defect prevention.