基层医疗卫生机构公共卫生服务工作量趋势变化与分析

Workload of Public Health Services in Primary Medical and Health Institutions:a Seven-year Trend Analysis

背景近年来对基层医疗卫生机构公共卫生服务的考核不断提质扩面,基层医疗卫生机构公共卫生服务的工作负荷值得关注。目的分析基层医疗卫生机构公共卫生服务工作量及类别构成的变化趋势,分析变化的原因。方法以上海市某社区卫生服务中心为研究对象,收集2010年1月—2016年12月的月度公共卫生服务工作量、服务类别及人员分工等信息,采用构成比分析、趋势描述与Joinpoint回归刻画工作量的时间变化。结果研究时段内该社区卫生服务中心的公共卫生服务工作量合计58937.83人天,月度工作量最高值为2016年12月的1020.79人天,最低值为2012年1月的461.56人天。Joinpoint回归结果显示,2011年2月前中心公共卫生服务工作量每月平均下降4.1%(P<0.05),后转为每月上升0.6%(P<0.05)。慢性病防治、妇幼保健、计划免疫、政府实事项目四类服务始终位于各年度工作量前4位,合计的构成比由2010年的71.97%上升至2016年的79.84%。研究时段内中心公共卫生人员的月度工作量中位值除2010年12月、2012年1月以外均高于法定值20.83 d,在2010、2015、2016年分别有6、5、9个月的月度工作量中位值高于30 d。结论基层医疗卫生机构公共卫生服务量自2011年平稳上升,重点工作构成持续增加,尤其慢性病防治明显提升,公共卫生人员人均负荷持续在高位运行。工作量随工作要求提高、人群需求变化、重大项目或阶段性重点工作而变化。未来规划应注重基本公共卫生服务与重大公共卫生服务项目的平衡,重视公共卫生人员高工作负荷的影响,强化“医防融合”以提升服务效率。

Background In the assessment of the performance of public health services in primary care recently,increasing attentions have been paid to quality-related dimensions of the services,but the volume of such services is also worthy of great concern.Objective To explore the changes in volume and category composition of public health services delivered by primary care and associated reasons.Methods Data were collected from a community health center in Shanghai,including monthly workload and categories of public services,and public health team task load during January 2010 to December 2016.Composition analysis,trend description and Joinpoint regressions were used to describe temporal changes in workload.Results During the study period,the total public health service workload of the community health service center was 58937.83 person days.The highest monthly workload was 1020.79 person days in December 2016 and the lowest was 461.56 person days in January 2012.Results from Joinpoint analysis showed that on average monthly workload declined by 4.1%before February 2011,and since then changed to a monthly increase of 0.6%(P<0.05).The top-ranked four categories in terms of workload had always been chronic disease prevention and treatment,maternal and child health care,vaccination services,and government's practical projects,the combined composition ratio of which rose from 71.97%in 2010 to 79.84%in 2016.The median monthly workload of public health staff was higher than the legal standard of 20.83 days except for December 2010 and January 2012.And there were 6,5,9 months in 2010,2015,and 2016,respectively with a median workload above 30 days.Conclusion Monthly workload of public health services for this community health center steadily increased since 2011,composition of key tasks continuously increased,in particular for prevention and treatment of chronic diseases,and workload of public health staff has been high.Workload varies with higher requirements,changes of population needs,and major public health programs or key projects in a specific phase.Future plans should focus more on the balance between essential public health services and major public health projects,impacts of heavy workload of public health staff,and treatment and prevention integration in order to improve the efficiency of services.