医共体模式下社区经外周静脉穿刺置入中心静脉导管维护推广的影响因素分析

Influencing factors of maintenance and promotion of peripherally inserted central catheter in community under the medical alliance model

目的了解医共体模式下社区经外周静脉穿刺置入中心静脉导管(PICC)维护推广的影响因素,为实现医共体社区内各站点PICC维护门诊的全覆盖提供依据。方法采用整群抽样法,于2021年1—2月选取杭州市参与医共体模式的10家社区中置入PICC的79例患者和参与PICC维护的67名社区护士为研究对象,采用患者调查问卷和护士调查问卷分别对患者和护士进行调查,采用单因素分析、Logistic回归分析医共体模式下社区PICC维护推广的影响因素,并对社区护士行PICC维护理论知识与操作进行考核。根据社区8个月内PICC推广情况,将PICC维护患者≥40例的3家社区设为推广优势社区,其余7家社区设为推广劣势社区,对比分析优劣势社区间推广结果的影响因素。结果患者调查的单因素分析中,付费方式、行动能力、交通方式、交通费用、接受随访、对社区就诊流程和维护技术满意度是医共体模式下社区PICC维护推广的影响因素(P<0.05)。护士调查的单因素分析中,宣传途径、绩效分配、排班方式、家庭医生团队和上门维护是医共体模式下社区PICC维护推广的影响因素(P<0.05)。优劣势社区护士PICC并发症知识与操作技能比较,差异具有统计学意义(P<0.05)。Logistic回归分析显示,患者行为能力、有无接受随访是社区PICC维护推广的影响因素(P<0.01)。结论基于医共体模式在社区开展PICC维护同质化培训与管理,利用家庭医生团队对置管患者落实常态化随访,简化社区PICC维护流程,加强多种途径宣传,持续提升社区护士PICC并发症处理能力,调整绩效分配方案等举措提升护士能动性,加强综合医院与社区双向转诊联动机制,对社区提供会诊支持,同时解决社区PICC维护规定病种报销途径等,可促进社区PICC推广维护。

Objective To understand the influencing factors of the maintenance and promotion of peripherally inserted central catheter(PICC)in the community under the medical alliance model,and provide a basis for realizing the full coverage of PICC maintenance clinics at each site in the medical community.Methods Using the cluster sampling method,a total of 79 patients with PICC in 10 communities participating in the medical alliance model in Hangzhou and 67 community nurses participating in PICC maintenance were selected as the research objects from January to February 2021.The patients and nurses were surveyed by using the patient questionnaire and the nurse questionnaire,respectively.Univariate analysis and Logistic regression were used to analyze the influencing factors of community PICC maintenance and promotion under the medical alliance model,and the theoretical knowledge and operation of PICC maintenance for community nurses were assessed.According to the 8-month promotion of communities,3 communities with more than or equal to 40 PICC maintenance patients were selected as the promotion advantage communities,and the remaining 7 communities were selected as the promotion disadvantage communities.And the influencing factors of promotion results among the superior and inferior communities were compared and analyzed.Results In the univariate analysis of the patient survey,payment method,mobility,transportation mode,transportation cost,receiving follow-up,satisfaction with community consultation process and maintenance technology were the influencing factors of community PICC maintenance and promotion under the medical alliance model(P<0.05).In the univariate analysis of the nurse survey,publicity channel,performance distribution,shift arrangement,family doctor team and door-to-door maintenance were the influencing factors of community PICC maintenance and promotion under the medical alliance model(P<0.05).There were statistically significant differences in knowledge and operation skills of PICC complications among superior and inferior community nurses(P<0.05).Logistic regression analysis showed that patients'behavior ability and whether they were followed up were the influencing factors of community PICC maintenance and promotion(P<0.01).Conclusions Based on the medical community model,the homogenization training and management of PICC maintenance should be carried out in the community,the family doctor team should be used to carry out regular follow-up for patients with catheterization,the maintenance process of PICC in the community should be simplified,the publicity of various ways should be strengthened,the ability of community nurses to deal with PICC complications should be continuously improved and the performance allocation scheme should be adjusted to improve the initiative of nurses.And strengthening the two-way referral linkage mechanism between the general hospital and the community,providing consultation support to the community and solving the reimbursement channels for diseases specified in the maintenance of community PICC can promote the promotion and maintenance of PICC in community.