深圳市养老机构医养结合资源配置与利用调查

Survey on the Supply and Utilization of Medical and Nursing Resources in Elderly Care Institutions in Shenzhen

目的调查深圳市养老机构医养结合资源配置与服务利用现况,为落实医养结合服务体系建设相关政策和规划提供依据。方法采用定量问卷,对深圳市设置有全日托管床位的养老机构进行横断面调查,分机构类型描述医养结合资源配置和服务利用现状。设计访谈提纲,对医养结合服务相关负责人进行访谈,分析养老机构中推进医养结合服务现状和问题。结果①38家机构中,12家(31.58%)持有医疗机构许可证,其中1家(2.63%)为医疗机构开设的护理院;25家(65.79%)与医疗机构进行签约提供医疗服务,1家(2.63%)未与医疗机构签约和开设医疗服务。②38家机构均可提供老人日常照料服务,部分医疗卫生服务的可获得性较差,急救服务和临终关怀服务为23.68%和50.00%。③38家养老机构拥有床位8454张,调查时点在院老年人3766人,入住率为44.54%,不同医养结合类型(χ^(2)=367.22,P<0.05)和不同运营性质(χ^(2)=858.91,P<0.05)机构入住率差异具有统计学意义。④养老机构内设医务室提供医疗服务困难,申请医保定点机构存在困难,签约医疗机构服务提供意愿低。结论深圳市养老机构医养结合服务取得了一定成效,但整体仍处于初步实践和探索阶段,存在按政策规划养老机构床位供给不足和实际入住率不高的状况。医疗服务,特别是急救服务的可获得性和硬件配置不完善和专业医务人员缺乏是主要缺口。

Objective To investigate the resource supply and service utilization of the combination of medical and nursing care in elderly care institutions in Shenzhen,so as to provide references for the implementation of relevant policies and plans for the construction of integrated medical and nursing care service system.Methods Questionnaire was used to conduct a cross-sectional survey of nursing institutions with full-time care beds in Shenzhen.We described the status quo of resource supply and service utilization of the combination of medical and nursing care by the types of sub-institutions.An interview outline was used to interview the relevant persons in charge of the integrated medical care service,and analyze the current situation and problems of promoting the integrated medical care service in elderly care institutions.Results①Among the 38 institutions investigated,12(31.58%)had practice licenses of medical institution,of which 1(2.63%)was a nursing home established by medical institution.Besides,25(65.79%)institutions had contracted with medical institutions to provide medical services,and 1(2.63%)had not contracted with medical institutions.②All 38 elderly care institutions can provide daily care services for the elderly,but the availability of some medical and health services was poor,such as the availability of emergency services and hospice care services were 23.68%and 50.00%,respectively.③There were 8454 beds and 3766 resident elderly people in all 38 elderly care institutions at the survey time-point,with the occupancy rate of 44.54%.The differences of institutional occupancy rates among different models of integrated medical and nursing care(χ^(2)=367.22,P<0.05)and different operation properties(χ^(2)=858.91,P<0.05)were statistically significant.④It is difficult to provide medical services by setting up infirmary in old-age care institutions,it is difficult to apply for designated institutions for medical insurance,and the willingness of contracted medical institutions to provide services is low.Conclusion The integrated medical and nursing care services of elderly care institutions in Shenzhen has made some achievement,but it is still in the preliminary practice and exploration stage.There is a deviation between the insufficient supply of beds and the low actual occupancy rate in elderly care institutions.And the availability of medical services,especially emergency services,as well as inadequate hardware and the shortage of medical professionals,are major gaps.