四川省基层医疗卫生机构状况及居家医疗服务开展现状调查

Investigation on the Situation of Primary Health Care Institutions and Home-based Medical Service in Sichuan Province

背景在老龄化程度日益加重、老年人就医需求多样化及目前医疗资源紧张的大背景下,居家医疗服务的需求不断增加。为此,国家大力鼓励发展居家医疗服务,四川省作为老年医疗居家护理服务的试点地区,当前开展主体为基层医疗卫生机构,探讨机构状况及服务开展现状十分必要。目的调查四川省基层医疗卫生机构状况及居家医疗服务开展现状,为进一步促进居家医疗的规范和发展提供参考。方法2021年8—10月,采用便利抽样法选取四川省7个城市、62所基层医疗卫生机构的相关负责人为研究对象,通过自行设计调查问卷,对该机构的一般资料、人力资源、居家医疗开展情况及阻碍因素进行资料收集和调查分析。结果62所基层医疗卫生机构中,全职医务人员10~316名,中位数为40(40)名;医务人员数量占全职员工的平均比重为(84.9±11.3)%;初级及以下职称医生占比的中位数为45.5%(24.2%),初级及以下职称护士占比的中位数为71.9%(34.2%);医护比为0.43~2.63,平均为(1.44±0.50)。机构不同所在地与是否参与等级医院评审、有兼职医护人员比较,差异有统计学意义(P<0.05);机构不同服务区域与机构名称、是否参与等级医院评审、有住院床位、医护占比、医护比、医护职称占比比较,差异有统计学意义(P<0.05)。有51所(82.3%)基层医疗卫生机构已开展居家医疗服务,慢病管理对居家医疗服务的开展有一定影响(P<0.05)。26所(50.9%)基层医疗卫生机构开展居家医疗服务时长<3年,31所(60.8%)机构服务最多的对象为≥60岁的老年慢病患者,35所(68.7%)工作量≤1~2 d/周,服务途径以家庭医生签约为主(98.0%)。开展居家医疗服务阻碍因素排名前三的是人力资源不足、无相应的标准和规范以及相应的配套政策支持不到位。结论基层医疗卫生机构的状况在不同地区和不同服务区域有所差别。居家医疗服务在四川省开展较广泛,但在服务形式、服务时间、工作量等方面还有待提升,建议各基层医疗卫生机构根据自身情况重视目前面临的问题,完善居家医疗服务相关标准和规范,重视慢病管理和机构人才队伍的建设,进一步推动居家护理的快速发展。

Background In the context of increasing aging,diversified medical needs of the elderly and the constrains of medical resources,the demand for home-based medical services is increasing.Therefore,the development of home-based medical services are strongly encouraged in China.Sichuan Province,as a pilot area for geriatric home-based medical services,is currently operating mainly in primary health care institutions,and it is necessary to explore its condition and the current situation of service development.Objective To investigate the condition and current situation of home-based medical service of primary health care institutions in Sichuan Province,so as to provide reference for further promoting the standardization and development of home-based medical services.Methods From August to October 2021,a convenience sampling method was used to select the relevant persons in charge of 62 primary health care institutions in 7 cities in Sichuan Province as the subjects.Through self-designed questionnaires,data collection and survey analysis were conducted on the general information,human resources,the development of home health care and obstacles of the situations.Results Among the 62 primary health care institutions,the number of full-time medical staff varied widely,ranging from 10 to 316,with a median of 40(40).The average proportion of medical staff to full-time employees was(84.9±11.3)%;the median percentage of physicians with junior titles or lower was 45.5%(24.2%),and the median percentage of nurses with junior titles or lower was 71.9%(34.2%);the medical-to-nursing ratio ranged from 0.43 to 2.63,with an average of(1.44±0.50).The differences were statistically significant when comparing the participation in accreditation of graded hospitals and part-time medical and nursing staff with the different locations of the institutions(P<0.05).There was a statistically significant difference in the service areas of the institutions when comparing the names of institutions,participation in the accreditation of graded hospitals,with inpatient beds,the proportion of medical staff,the ratio of doctors to nurses,the proportion of professional titles of medical staff(P<0.05).Fifty-one(82.3%)institutions had carried out home-based medical services,and there was an effect of chronic disease management on the development of home-based medical services(P<0.05).The service duration of 26 institutions(50.9%)was less than 3 years,31 institutions(60.8%)were mainly serving elderly patients≥60 years old with chronic diseases,35 institutions(68.7%)had a workload of≤1-2 days/week,and the service pathway was dominated by family doctor contract service(98.0%).The top three obstacles to the development of the home-based medical services were insufficient human resources,lack of corresponding standards and norms,and inadequate appropriate supporting policies.Conclusion The condition of primary health care institutions were distinct in different regions and service areas.The home-based medical services were widely available in Sichuan Province,but there is still room for improvement in terms of service forms,service hours and workload.It is suggested that all institutions should pay attention to the problems facing the current development according to their own conditions,improve the standards and norms related to home-based medical services,pay attention to chronic disease management and the construction of talent team,and further promote the rapid development of home-based medical services.