上海市社区卫生服务中心口腔诊室建设情况调查及城郊差异分析

Survey on availability of dental services in Shanghai community health service centers and differences between urban and suburban areas

目的了解上海市社区卫生服务中心口腔诊室的建设情况及城郊差异。方法该研究为横断面研究。于2023年3月10—17日,采用问卷调查的形式通过自行设计的《上海市社区卫生服务中心口腔诊疗服务能力调查表》,收集上海市249家社区卫生服务中心的口腔诊室相关信息,根据上海市卫生统计年鉴的分区类型分为中心城区、近郊地区、远郊地区3类,从口腔诊室基本设施、开展的临床诊疗项目、人员结构等方面比较城郊差异情况。结果调查有效问卷回收率为100.0%(249/249)。(1)全市249家社区卫生服务中心中,220家设置了口腔诊室(88.4%),29家(11.6%)未设置,近郊地区、中心城区和远郊地区设置了口腔诊室的社区卫生服务中心占比分别为98.2%(107/109)、95.0%(76/80)和61.7%(37/60),近郊地区>中心城区>远郊地区(H=35.44,P<0.05)。口腔诊室硬件设施基本情况:220家社区卫生服务中心中,近郊地区、中心城区和远郊地区的口腔诊室建筑面积分别为40.00(28.50,73.24)、31.70(24.40,49.35)和20.00(16.75,34.00)m2,近郊地区>中心城区>远郊地区(H=25.07,P<0.05);检查设备方面,综合治疗椅、X线全景机、X线牙片机、口腔种植仪、超声洁牙机、便携式牙椅、光固化灯、加酶清洗机配置情况城郊地区差异均有统计学意义(H=35.44、8.32、25.53、7.46、20.95、43.00、23.22、13.35,均P<0.05)。(2)口腔诊室开展服务项目情况:220家设置口腔诊室的社区卫生服务中心中,可开展龋齿充填的有220家(100.0%)、根管治疗175家(79.55%)、各类阻生牙拔除161家(73.18%),颌面外科小手术104家(47.27%)、固定义齿修复132家(60.00%),可摘局部义齿修复139家(63.18%);少数社区可开展口腔正畸和种植:包括活动矫正20家(9.09%)、固定矫正11家(5.00%)和口腔种植9家(4.09%)。城郊地区根管治疗、龈上洁治术、龈下刮治术、各类阻生牙拔除、颌面外科小手术、固定义齿修复、可摘局部义齿修复、活动矫正、口腔种植修复开展情况比较,差异均有统计学意义(H=29.19、51.73、25.32、31.93、8.23、25.98、28.26、10.46、7.84,均P<0.05)。(3)人员结构情况:220家设置口腔诊室的社区卫生服务中心,共有口腔医师511名,其中硕士研究生24名(4.70%),副高级专业技术职称者53名(10.37%);城郊地区口腔医师数、本科及以下学历、硕士研究生学历、中级及以下职称人数比较,近郊地区>中心城区>远郊地区(H=66.35、50.33、11.19、42.17,均P<0.05)。结论上海市社区卫生服务中心口腔服务能力具备一定的基础,但中心城区、近郊地区和远郊地区差异较大,其中近郊地区发展较好,中心城区在建筑面积等方面需要加强,远郊在设施设备、人才队伍方面需要加强。

Objective To survey the availability of dental services in Shanghai community health service centers and the differences between urban and suburban areas.Methods A questionnaire survey on dental service in Shanghai community health service centers were conducted from March 10 to 17,2023.The availability of dental services and the differences among health service centers in central urban area,urban area and suburban area were analyzed.Results A total of 249 community health service center participated in the survey and 249 effective questionnaires were returned with a response rate of 100.0%.Among 249 centers,220(88.4%)had set up dental clinics.The proportion of community health service centers with dental clinics in the urban areas,central urban areas and suburban areas is 95.0%(76/80),98.2%(107/109)and 61.7%(37/60),respectively(H=35.44,P<0.05).Among the 220 centers with dental clinics,the floor space of dental clinic was 40.00(28.50,73.24),31.70(24.40,49.35)and 20.00(16.75,34.00)square meters in suburban areas,central urban areas,and suburban areas,respectively.There were significant differences in the inspection equipment including comprehensive dental chairs,X-ray panoramic machine,X-ray dental machine,dental implants,ultrasonic dental cleaning machine,portable dental chairs,light curing lamps,and enzyme cleaning machine among community health service centers in three types of city areas(H=35.44,8.32,25.53,7.4620.95,43.00,23.22,13.35,all P<0.05).Among 220 centers with dental services,all provided dental caries filling,175(79.55%)provided root canal treatment,161(73.18%)provided extraction of various impacted teeth,104(47.27%)provided minor maxillofacial surgery,132(60.00%)provided fixed denture restoration,and 139(63.18%)provided removable local denture restoration.Only a few centers provided orthodontics and dental implant services,including 20 provided removable orthodontics(9.09%),11 provided fixed orthodontics(5.00%),and 9 provided dental implants(4.09%).There were significant differences in provision of services for root canal treatment,gingival scaling,subgingival scraping,various types of impacted tooth extraction,maxillofacial surgery minor surgery,fixed denture restoration,removable local denture restoration,mobile correction,and oral implant restoration among centers in three types of city areas(H=29.19,51.73,25.32,31.93,8.23,25.98,28.26,10.46,7.84,all P<0.05).There were total 511 dentists in 220 community health service centers,including 24(4.70%)with master degree,53(10.37%)with associate senior professional titles.There were significant differences in number of dentists,those with undergraduate and below education,those with master degree,those with intermediate and below professional titles among centers in three types of city areas(H=66.35,50.33,11.19,42.17,all P<0.05).Conclusion Community health service centers in Shanghai generally have basic capacity of dental service,but there are significant differences among the central urban areas,suburban areas,and suburban areas,indicating that it need to be further strengthened in terms of facilities,equipment,and talent team development in different city areas accordingly.