潍坊市区基层中医发展现状的调查与分析

Investigation and Analysis of the Development Status of Grass-roots Traditional Chinese Medicine in Weifang City

目的:调查潍坊市区基层中医发展现状,分析归纳出基层中医发展存在的问题,提出对策建议。方法:2019年6月-2020年6月采取调查问卷和深入访谈相结合的方式全面了解潍坊市区(奎文区、潍城区、坊子区、高新区、寒亭区)129家基层中医机构(社区卫生服务中心和中医诊所)的中医药服务基础条件、中医药医疗服务指标等现状,及其139位医从业人员的基本情况、中医理论和临床水平,分析基层中医存在的问题,并提出相应的对策和建议。结果:129家基层中医机构中有127家填写了业务用房面积,其中110家(86.6%)>80 m^(2),17家(13.4%)60~80 m^(2)。124家填写了中医药业务用房面积,其中53家(42.7%)10~30 m^(2),占比最高。75家填写了中药饮片种类,其中43家(57.3%)为100~199种,占比最高。107家填写了是否设置中药饮片单间,其中61家(57.0%)未设置。82家填写了中药饮片服务的相应设备名称,其中74家(90.2%)设置消毒锅,占比最高。114家填写了开展的中医药适宜技术,开展最多的是艾灸(97.4%),其次是针刺(79.8%)和刮痧拔罐(50.9%)。139位中医从业人员中64位(46.0%)39~49岁占比最高;无研究生,中专74位(53.2%)占比最高。无主任医师,住院医师91位(65.5%)占比最高;45位(32.4%)中药种类识别<100种;119位(85.6%)未掌握中药炮制,48位(34.5%)背诵<100首方剂,50位(36.0%)未能背诵四大经典,均占比最高。2016-2018年每家机构中医门诊量与中药饮片处方量逐渐增加,中医非药物处方量也有所增加,但中医药收入变化不大。深入访谈总结出问题包括宣传不当、同行之间存在恶性竞争、医药分家、诊疗不规范及中医药适宜技术开展项目不足。结论:潍坊市区基层中医发展不均衡,应当在中医药服务基础条件、中医药人才引进和培养、中医药服务能力等方面进一步提高。

Objective:To investigate the current situation of the development of grass-roots traditional Chinese medicine in Weifang City,analyze and summarize the existing problems in development of grass-roots traditional Chinese medicine,and put forward some countermeasures and suggestions.Method:From June 2019 to June 2020,questionnaires and in-depth interviews were conducted to comprehensively understand the basic conditions and indicators of traditional Chinese medicine services of 129 grass-roots traditional Chinese medicine institutions(community health service centers and traditional Chinese medicine clinics)in Weifang City(Kuiwen District,Weicheng District,Fangzi District,High Tech Zone and Hanting District),as well as the basic situation,theoretical and clinical level of 139 medical practitioners.The problems existing in grass-roots traditional Chinese medicine were analyzed,and corresponding countermeasures and suggestions have been put forward.Result:Among the 129 grass-roots traditional Chinese medicine institutions,127 filled in the business room area,among which 110(86.6%)were>80 m^(2) and 17(13.4%)were 60-80 m^(2).124 of them filled in the area of traditional Chinese medicine business,among which 53(42.7%)were 10-30 m^(2),accounting for the highest proportion.75 of them filled in types of Chinese medicine decoction piece,43(57.3%)were 100-199 types,accounting for the highest proportion.107 of them filled in whether to set up Chinese medicine decoction piece single room,61(57.0%)did not have single rooms for Chinese medicine decoction pieces.82 of them filled in the corresponding equipment name of Chinese medicine decoction piece service,among which 74(90.2%)set disinfection pot,accounting for the highest proportion.114 of them filled in the appropriate technologies of traditional Chinese medicine,moxibustion(97.4%)was the most popular,followed by acupuncture(79.8%)and scrapping cupping(50.9%).Among 139 traditional Chinese medicine practitioners,64 people(46.0%)were aged from 39 to 49 years old,accounting for the highest proportion.No graduate students,74 people(53.2%)in technical secondary schools accounted for the highest proportion.There were no chief physicians and 91 resident physicians(65.5%)accounted for the highest proportion.45 people(32.4%)category identification of Chinese medicine<100 types.119 people(85.6%)did not master the processing of Traditional Chinese medicine.48 people(34.5%)recite<100 prescriptions.50 people(36.0%)failed to recite the four classics,accounting for the highest proportion.From 2016 to 2018,the number of traditional Chinese medicine outpatient visits and prescriptions for traditional Chinese medicine decoction pieces gradually increased in each institution,and the number of prescriptions for traditional Chinese medicine non-drug medicines also increased,but the traditional Chinese medicine income did not change much.The problems summarized in the in-depth interview include improper publicity,vicious competition among peers,division of medicine,non-standard diagnosis and treatment,and insufficient development of traditional Chinese medicine appropriate technology.Conclusion:The development of grass-roots traditional Chinese medicine in Weifang City is not balanced,which should improve the basic condition of TCM service,the introduction and training of traditional Chinese medicine talents,and the capacity of traditional Chinese medicine service.