基层中医药健康管理服务质量影响因素模型构建及政策建议

Construction of influencing factors model and policy recommendations for quality of primary traditional Chinese medicine health management services

目的构建基层中医药健康管理服务质量影响因素模型,并提出相应的政策建议。方法本研究为横断面研究,采用典型抽样和随机抽样相结合的方法,于2022年8—10月抽取浙江省15个社区39名基层中医药健康管理服务知情人,针对服务开展项目、实施效果和影响因素进行访谈,基于扎根理论研究方法对访谈记录进行三级编码,根据编码后结果构建基层中医药健康管理服务质量影响因素模型,并提出相应的政策建议。结果对39份原始访谈资料进行开放式编码,共获得516个参考点,形成了与主题相关的53个初始概念,并归纳为17个一级范畴。通过主轴编码进一步归纳,提取出“政策环境”“健康素养”“社区定位”“能力建设”“健康偏好”“利益冲突”6个主范畴,通过选择式编码分析6个主范畴之间的逻辑关联,以服务质量影响因素的故事线为基础构建了影响因素模型。该模型的故事线为:首先,政策环境是服务质量的外部保障;其次,作为服务需求侧,居民的健康素养、健康偏好是服务质量的调节因素;最后,社区作为服务供给侧,服务能力是关键影响因素,社区职能和目标定位是内驱因素,内/外部利益冲突则对服务质量起到反向制约作用。结论现阶段对基层中医药外部政策环境保障力度有限,服务需求侧重视不足,服务供给侧功能也存在缺位,应进一步完善外部政策环境,深化中医药服务领域的供需对接,持续推进基层中医药服务能力建设,平衡中医药相关部门利益,进而提升服务质量。

Objective To construct the impact factor model of primary traditional Chinese medicine(TCM)health management service quality,and put forward corresponding policy suggestions.Methods In this cross-sectional study,the typical sampling and random sampling method were used to select 39 insiders of primary TCM health management service from 15 communities in Zhejiang Province from August to October in 2022.Interviews on service projects,implementation effects and impact factors were conducted,the three-level coding of interview record was carried out using the grounded theory research method,a model of impact factor for health management service quality of basic TCM was constructed,and the corresponding policy recommendations were put forward.Results Based on the open coding of 39 original interview data,a total of 516 reference points were obtained,and 53 initial concepts related to the topic were formed and summarized into 17 first-level categories.Through the summary of main axis coding,6 main categories of“policy environment”,“health literacy”,“community orientation”,“capacity building”,“health preference”and“conflict of interest”were extracted.The logical correlation between the six main categories were analyzed with selective coding,an impact factor model was constructed in accordance with the story line of factors affecting service quality.The story line of this model was as follows:first,the policy environment was the external guarantee of community TCM service quality;second,as the demand-side of the services,the health literacy and requirement of residents was the regulatory factor for service quality;in addition,the community played the role of the supply-side of the services,the service ability construction was the key factor,and the community functions and target orientation was the internal driving factor,meanwhile,the internal/external conflicts of interest had a negative constraint on the service quality.Conclusions The guarantee intensity of external policy environment is limited,the service demand side pays insufficient attention,and the service supply side functions are absent at the present stage.It is necessary to improve the external policy environment,deepen the connection between supply and demand sides in the field of TCM health service,promote the capacity building of TCM service at the grass-roots level,balance the interests of relevant departments of TCM service,in order to improve the quality of TCM health management service at the grass-roots level.