我国居民健康档案的建立及利用情况:基于东中西三省份的需方调查

Creation and Utilization of the Health Records in Residents:a Demand-side Survey in Three Eastern,Central and Western Chinese Provinces

背景居民健康档案建设是深化医药卫生体制改革提出的重点任务,是促进基本公共卫生服务均等化的重要举措。目前,我国关于健康档案的研究多局限在某个城市或社区内,基于全国范围的从需方角度开展的跨省份研究相对缺乏。目的了解居民健康档案的建立及利用情况。方法基于“基本公共卫生服务项目”的服务人群,将调查对象分为0~6岁儿童、孕产妇、≥65岁老年人、高血压患者、糖尿病患者、一般人群6类。于2019年11—12月,采用多阶段抽样法,在我国东、中、西部各抽取1个省份(浙江省、山西省、重庆市)的1个区和1个县,在相应区(县)内随机抽取2家社区卫生服务中心/乡镇卫生院及其所辖社区卫生服务站和村卫生室。最终抽取20家社区卫生服务中心/乡镇卫生院,对前来机构就诊的居民开展问卷调查,调查内容包括居民健康档案建立情况、可查看情况、查看方式及满意度。结果最终纳入居民10067例,9119例自述已建立健康档案,建档率为90.58%。其中,0~6岁儿童的建档率为94.09%(2787/2962)、孕产妇的建档率为95.60%(956/1000)、≥65岁非高血压/糖尿病老年人的建档率为87.87%(616/701)、≥65岁高血压患者的建档率为88.87%(1414/1591)、<65岁高血压患者的建档率为92.91%(747/804)、≥65岁糖尿病患者的建档率为89.41%(895/1001)、<65岁糖尿病患者的建档率为92.72%(471/508)、一般人群的建档率为82.20%(1233/1500)。在建立了健康档案的居民中,67.02%(5990/8938)可以随时查看健康档案,12.40%(1108/8938)反映不能查看健康档案,20.59%(1840/8938)表示从未查看过健康档案。5990例可随时查看健康档案的居民中,查看方式以纸质健康档案居多〔4538例(75.76%)〕。83.31%(4352/5224)的居民对健康档案服务表示满意。不同省份、区(县)类型、家庭人均月收入、学历、人群类别居民的建档率、健康档案可查看率比较,差异有统计学意义(P<0.05);不同省份、就诊机构类型、区(县)类型、家庭人均月收入、学历、人群类别居民对健康档案建立与利用情况的满意度比较,差异有统计学意义(P<0.05)。结论近年来,我国居民健康档案建档率有明显提高,利用率有所改善但仍有待提高,居民满意度尚可。

Background The creation of health records for Chinese residents is a key task for deepening the reform of the pharmaceutical and healthcare system,and an important action for promoting the equity of essential public health services.However,domestic studies on resident health records are mainly using the data from a city or community,and those using the national data from a demand-side perspective are rather scarce.Objective To understand the creation and utilization of health records in Chinese residents.Methods From November to December 2019,multistage sampling was used to select three provinces/municipality(Zhejiang,Shanxi and Chongqing)from eastern,central and western China(one was extracted from each geographical region),then from each of them,one urban district and one county were extracted.Randomly selected 2 community health centers/stations,township health centers/village clinics in the corresponding districts(counties).Finally,20 community health service centers/township health centers were selected,the visitors of these institutions were invited to attend a questionnaire survey for understanding their information about the creation of health records,and the access to the health records,as well as satisfaction with the services.For ease of analysis,the visitors were classified into six categories(0-6-yearolds,pregnant women,over 65-year-olds,hypertensioners,diabetics,and general population)in accordance with the population groups defined in the Essential Public Health Service Programs.Results Altogether,10067 residents were included for final analysis.Among them,9119(90.58%)self-reported that they had received health records creation services.The rates of creation of health records in 0-6-year-olds,pregnant women,over 65-year-olds without hypertension/diabetes,over 65-year-olds with hypertension,under 65-year-olds with hypertension,over 65-year-olds with diabetes,and under 65-yearolds with diabetes,as well as general population were 94.09%(2787/2962),95.60%(956/1000),87.87%(616/701),88.87%(1414/1591),92.91%(747/804),89.41%(895/1001),92.72%(471/508),and 82.20%(1233/1500),respectively.Among those with health records created,67.02%(5990/8938)could access to their health records at any time,and the health records accessed by most of them were printed〔75.76%(4538/5990)〕.However,12.40%(1108/8938)of residents reported that they had no access to their health records,and other 20.59%(1840/8938)indicated that they had never tried to gain access to their health records.The rate of satisfaction with health records services in residents was 83.31%(4352/5224).The rate of health records creation and rate of accessing the health records differed significantly by province,district or country,household monthly income per person,education level,and category of population(P<0.05).The rates of satisfaction with the creation of and access to health records differed significantly by province,type of visited health institution,district or country,household monthly income per person,education level,and category of population(P<0.05).Conclusion Generally,the rate of creation of health records in Chinese residents has significantly increased.The rate of utilization of the records has also enhanced,but needs further improvement.Moreover,residentssatisfaction with health records services may be at a moderate level.