乡村一体化对乡村医生角色压力的影响研究——以山西省紧密型医共体为例

Studying on the Influence of Rural Integration on the Role Pressure of Rural Doctors Sampled with the Close Medical Community in Shanxi

目的:了解紧密型县域医共体背景下乡村医生角色压力情况,分析“乡村一体化”改革对乡村医生角色压力的影响。方法:使用基础情况调查表、角色压力量表对多阶段整群抽样选取的417名乡村医生进行调查;将已实施“乡村一体化”管理的村医样本与未实施的样本进行分组比较;运用访谈法、描述性分析、单因素方差分析、多元线性回归对数据进行分析。结果:乡村医生角色压力总得分为(3.27±0.549),各维度得分为角色冲突(3.77±0.827),角色模糊(2.26±0.869),角色超载(3.98±0.775);不同性别、年龄、学历、工龄、月均收入、是否承担家庭农务工作的乡村医生角色压力有差异(P<0.05);多元线性回归结果显示,与未实施“乡村一体化”管理地区的乡村医生相比,已实施地区村医角色压力总得分、角色冲突得分、角色超载得分较高,角色模糊得分较低(P<0.05)。结论:紧密型县域医共体背景下乡村医生角色压力在中等偏上水平,主要来自于角色冲突和角色超载;“乡村一体化”改革会增加乡村医生的角色压力,具体维度上表现为增大角色冲突和角色超载,减小角色模糊;建议持续深入推进“乡村一体化”,同时建立乡村医生有效激励机制,促进乡村全科医生角色顺应,降低角色压力。

Objective To understand the role pressure of rural doctors under the background of close county medical community,and analyze the impact of"rural integration"reform on the role pressure of rural doctors.Methods 417 rural doctors were selected by multi-stage cluster sampling method,and surveyed with basic situation questionnaire and role stress scale.The samples of village doctors who had implemented"rural integration"management were compared with the samples who had not been implemented.Data were analyzed by interview,descriptive analysis,one-way ANOVA and multiple linear regression.Results The total score of role stress of rural doctors was(3.27±0.549).And the score of each dimension was 3.77±0.827 in role conflict,2.26±0.869 in role ambiguity and 3.98±0.775 in role overload.There were different role stress scores of rural doctors with different gender,age,educational background,length of service,average monthly income and whether to undertake family agricultural work(P<0.05).The results of multiple linear regression showed that,compared with rural doctors in areas without"rural integration"management,the total score of role pressure,role conflict score and role overload score of rural doctors in implemented areas were higher,and the role ambiguity score was lower(P<0.05).Conclusion Under the background of compact county medical community,the role pressure of rural doctors is above the middle level,which is mainly from role conflict and role overload."Rural integration"reform will increase the role pressure of rural doctors,which is manifested in increasing role conflict and role overload and reducing role ambiguity.It is suggested to continuously and deeply promote"rural integration",and establish an effective incentive mechanism for rural doctors,which can promote the role adaptation of rural general practitioners and reduce their role pressure.