基于LASSO-Logistic方法的乡镇卫生院医防融合服务提供现状影响因素研究

A Study on the Status of Medical and Preventive Integration Services in Township Health Centers and Its Influencing Factors Based on the LASsO-Logistic Approach

目的:本研究旨在识别影响乡镇卫生院医防融合服务提供现状的关键因素,以期为基层卫生机构医防融合服务存在问题的成因与对策提供参考。方法:采用分层整群抽样法,调查有效问卷4892份,并运用描述性分析、卡方检验、LASSO-Logistic以及常规Logistic方法对数据进行系统分析。结果:最终析出16个非零系数的自变量,发现社会人口学维度的卫生院等级(0R=1.325,P<0.001)、专业(0R=1.285,P=0.026)等;医防融合认知情况维度中医防融合重要性评价(0R=4.414,P<0.001)以及医防融合了解程度(0R=5.230,P<0.001)等;以及临床工作与预防工作模式沟通不畅,医防融合的落脚点不明确(0R=1.534,P<0.001)等变量是关键影响因素。结论:建议统筹规划、分类指导乡镇卫生院,以中心卫生院为主,参考一般乡镇卫生院的实际情况,因地制宜地推动各乡镇卫生院的发展。明晰不同主体的职责范围,激发医务人员对预防保健服务的认知度和重视度,加强医防融合复合型人才队伍建设与培训,以提升乡镇卫生院医防融合服务水平。

Objective To identify the key factors affecting the medical and preventive integration services in township health centers,and provide references for studying the causes and countermeasures of the problems of medical and preventive integration services in primary health institutions.Methods 4892 valid questionnaires were surveyed by using the stratified cluster sampling method,and systematically analyzed using descriptive analysis,chi-square test,LASSO-Logistic,and conventional Logistic methods.Results Sixteen independent variables with non-zero coefficients were finally analyzed.And it was found that the health center grade(OR=1.325,P<0.001),and specialty(OR=1.285,P=0.026)of social demographic dimension,evaluation of the importance of health care and prevention integration(OR=4.414,P<0.001),and the degree of knowledge of health care and prevention integration(OR=5.230,P<0.001)of the dimension of cognitive situation of health care and prevention integra-tion,and variables such as poor communication between clinical and preventive work models and unclear landing point of medical and preventive integration(OR=1.534,P<0.001)were the key influencing factors.Conclusion It is recommended that town-ship health centers should be integratedly planned and classified to guide their development,with central health clinics as the main focus and with reference to the actual situation of general township health centers,and to promote their development in accordance with local conditions,clarify the scope of responsibilities of different subjects,stimulate the awareness and attention of medical personnel to preventive health care services,and strengthen the construction and training of the medical and preventive integration complex talent team,which can improve the level of medical and preventive integration services in township health centers.