上海市社区母婴保健服务存在问题分析

Analysis of problems in maternal and child health services in communities of Shanghai

目的分析上海市社区母婴保健服务中存在的问题,为推动社区母婴保健工作持续改进与提升提供参考。方法在知网、万方、维普、中国生物医学文献数据库和PubMed检索获得上海市社区母婴保健服务相关文献进行文本分析,检索时限为2009—2023年。2022年8月至2023年5月,采用目的抽样法,在上海市选取社区卫生服务中心进行参与式观察,并对社区母婴保健服务提供人员、各级管理人员及参与医联体建设的三级医院产科专家进行访谈,了解社区卫生服务中心提供母婴保健服务过程中存在的问题等,综合文本分析、参与式观察及访谈结果,采用结构-过程-结果理论模型梳理形成上海市社区母婴保健服务问题清单。根据问题清单制作电子问卷,邀请各辖区的社区母婴保健服务相关人员从重要性、严重性和可解决性3个方面对存在问题进行评分,根据各问题的总得分确定关键问题。结果形成了包含24个问题的上海市社区母婴保健服务问题清单,其中结构维度包括队伍建设和硬件设施,过程维度包括机制建设、实施过程和机构协调,结果维度仅包括系统结果。根据问卷调查结果,将问题总得分>7分的3个问题确定为关键问题,分别为服务人员的母婴保健专科知识和技能有待提升;服务人员配置数量不足,缺乏专职人员和专科人才;卫生信息平台不健全,机构间尚不能全面、及时共享诊疗数据。结论本研究确定了上海市社区母婴保健服务问题清单及当前亟待解决的关键问题,可为提升上海市社区母婴保健服务质量提供参考。

ObjectiveTo analyze the existing problems in maternal and child health services in Shanghai′s communities,so as to provide references for the continuous improvement and enhancement of maternal and child health work in community.MethodsRetrieve relevant literature on community maternal and child health services in Shanghai from databases such as CNKI,Wanfang,VIP,Chinese biomedical literature database and PubMed for text analysis,with a search period from 2009 to 2023.From August 2022 to May 2023,a purposive sampling method was used to select community health service centers in Shanghai for participatory observation.Interviews were conducted with maternal and child health service providers in community,management personnel at all levels,and obstetric experts from tertiary hospitals participating in the construction of medical alliances to understand the problems that exist in the process of providing maternal and child health services in community service centers.Based on text analysis,participatory observation,and interview results,a structure-process-outcome theory model was used to sort out a list of problems of maternal and child health services in Shanghai′s community.An electronic questionnaire was created based on the list of questions,and maternal and child health service personnel in each jurisdiction were invited to rate the existing problems from three aspects:importance,severity,and solvability.The key issues was determined based on the total score of each problem.ResultsA list of 24 issues related to maternal and child health services in Shanghai′s community has been formed,with the structural dimension including team building and hardware facilities,the process dimension including mechanism construction,implementation process,and institutional coordination,and the result dimension only including system result category.According to the survey results,the three key questions with a total score greater than 7 were identified as the need for improvement in the maternal and child health knowledge and skills of service personnel;Insufficient staffing of service personnel,lack of dedicated personnel and specialized talents;The health information platform was not well-established,and institutions could not fully and timely share diagnosis and treatment data.ConclusionsThis study has identified a problem list for maternal and child health care services in Shanghai′s communities,as well as key issues that urgently need to be addressed,which can provide reference for improving the quality of maternal and child health care services in Shanghai′s communities.