杭州市社区卫生服务机构健康管理服务现状及对策研究
发布时间：2019-05-22 20:39
【摘要】：目的:通过对杭州市6家社区卫生服务中心的健康管理服务情况展开供需双方的调查,了解社区居民对健康管理服务的需求、利用及满意度现状和主要影响因素,提出社区健康管理服务进一步发展的对策,为政府及社区卫生服务机构开展社区健康管理提供参考依据。方法:1.文献研究。通过对健康管理、社区健康管理服务相关概念及其研究与实践进展的回顾研究,为探究社区健康管理服务现状及发展对策奠定理论基础。2.问卷设计与调研。通过文献阅读、专题小组讨论和专家咨询等方法设计调查问卷,采用分层随机抽样方法,在杭州市主城区抽取6家社区卫生服务中心,利用自行设计的《杭州市社区健康管理服务机构调查表》对样本社区卫生服务中心人、财、物与服务内容等基本情况进行调查;运用自行设计的《健康管理服务对象需求、利用及满意度调查问卷》对接受过健康管理服务的居民进行调查,共调查服务对象410名。3.数据统计与分析。使用Epidata3.1建立数据库并录入数据,使用SPSS20.0对数据进行统计分析;采用Cronbach'sα信度系数检验问卷信度,因子分析法和Pearson相关系数检验问卷效度;利用描述性分析、秩和检验、二元Logistic回归分析影响社区居民健康管理服务满意度的评价因素;使用TOPSIS分析法评价社区卫生服务中心健康管理服务的优劣。结果:供方调查显示:1.人员配置方面:所调查机构在职人员数量相差较大,在87-132人之间,且人员配置以执业医师数量最多;工作人员学历以本科及以下为主,研究生及以上学历占比均在10%以下,各机构每万人口全科医生占比在2-14人之间。2.提供健康管理服务方面:(1)针对全人群开展的健康管理服务中,电子健康档案使用率和健康档案合格率均在80%以上,但健康档案使用率仅达到50%;各机构均开展了形式多样的健康教育,且更新次数较为频繁。(2)针对重点人群开展的健康管理服务中,儿童、孕产妇健康管理各项指标均在90%以上,但老年人健康管理率在40%-70%之间。(3)针对慢性病人群开展的健康管理服务中,高血压、糖尿病、重性精神疾病患者规范管理率在7.64%-72.10%、10.09-71.9%和57.97%-100%之间。(4)在健康检测与评估服务、健康指导与干预服务方面各机构的服务内容和方式各有侧重。需方调查显示:1.问卷信效度分析。问卷需求部分各维度的Cronbach'sα系数均大于0.83,总体的Cronbach'sα系数为0.901,信度良好;KMO值为0.887(P0.001),各维度的累计方差解释率为69.659%,结构效度良好;需求各维度与总体需求相关系数为0.863-0.950之间,内容效度良好。问卷满意度评价部分各维度的Cronbach'sα系数均大于0.85,总体的Cronbach'sα系数为0.916,信度良好;KMO值为0.916(P0.001),各维度的累计方差解释率为87.992%,结构效度良好;满意度各维度与总体满意度相关系数为0.764-0.939之间,内容效度良好。2.调查对象的健康状况:13.2%的调查对象近两周内有患病情况、19.6%的调查对象至少患有一种慢性病、健康状况自我评价以一般(47.3%)和较好(38.5%)为主。健康管理服务总体需求和满意度的平均得分依次为3.88分和3.63分。3.健康管理服务知晓、利用情况:59.2%被调查居民知晓健康档案服务,53.2%被调查居民知晓责任医师服务;被调查居民接受过的健康管理服务前三位分别是健康体检(72.8%)、健康档案(35.4%)和健康风险评估服务(20.4%)。4.健康管理服务需求情况:需求得分最高的前三项分别为健康体检、健康档案、疾病管理服务。通过比较不同区域健康管理服务需求的差异情况可知:下城区调查人群比江干区人群健康体检与评估服务需求程度高(P0.05)。责任医师服务的知晓情况、最常去的健康管理服务机构、医疗保险类型、对社区健康管理服务的满意度情况是居民健康管理服务需求的主要影响因素。5.健康管理服务满意度情况:居民对提供服务频率、服务项目、诊疗设备3个方面最不满意。江干区和下城区居民对健康管理服务各维度满意度的评价均没有显著性差异(P0.05)。最常去的健康管理机构类型、慢性病患病情况及对健康管理服务的需求是社区居民健康管理服务总体满意度的主要影响因素。TOPSIS综合评价排序结果显示,社区卫生服务中心D综合满意度最高,中心A综合满意度最低。结论:1.供方调查结论。所调查社区卫生服务机构人力资源配置不尽合理,机构人员受教育程度待提升,健康档案使用率、老年人健康管理率、高血压和糖尿病患者规范管理率仍然较低。各机构均提供了较为统一和完善的健康管理服务项目,但开展的中医药健康管理服务内容仍待完善,提供体检服务的内容、健康指导和健康教育的方式机构间仍存在差距。2.需方调查结论。居民对社区健康管理服务需求度较高,但对健康管理相关服务项目知晓度和除常规体检外的各项健康管理服务利用水平较低。社区卫生服务机构管理者应采取有效措施提升服务对象的服务内容满意度,特别是服务频率方面。3.对策建议。建议政府部门加强人力保障、财力支持、物力供给及政策支撑,社区卫生服务机构加强以需求为引导的健康管理、及时调整服务内容、改善服务态度和质量、加强宣传监督指导、重视人才队伍建设、积极与外界加强合作、重视居民的反馈和评价,通过政府与社区卫生服务机构的协作来推动社区健康管理服务良性发展。
[Abstract]:Objective: To study the health management service of 6 community health service centers in Hangzhou, and to investigate the demand, utilization and satisfaction of community residents on the health management service and the main influencing factors. The countermeasures of the further development of the community health management service are put forward, and the reference basis for the community health management of the government and the community health service institution is provided. Method:1. Literature study. Through the review of the concept of health management and community health management service and the progress of its research and practice, the paper lays a theoretical foundation for exploring the present situation and the development of community health management service. Questionnaire design and research. The questionnaire was designed by means of literature reading, panel discussion and expert consultation, and six community health service centers were selected in the main urban area of Hangzhou by means of stratified random sampling. A self-designed questionnaire for community health management service in Hangzhou is used to investigate the basic conditions such as human, financial, material and service contents of the sample community health service center, and the self-designed health management service object needs are used. The survey of the residents who received the health management service was investigated by using the questionnaire of satisfaction survey, and 410 of the service objects were investigated. Data statistics and analysis. Using Epidata3.1 to set up the database and enter the data, the data was analyzed by using the SPSS10.0. The validity of the questionnaire, the factor analysis method and the Pearson correlation coefficient were used to check the validity of the questionnaire. The descriptive analysis, rank and test were used. The two-dimensional logistic regression analysis influences the evaluation factors of the satisfaction of the community residents' health management service. The TOPSIS analysis method is used to evaluate the health management service of the community health service center. Results: The supplier survey showed:1. in that aspect of personnel configuration, the number of the active staff of the investigated institution is relatively large, between 87 and 132, and the staffing of the personnel is the most in the number of medical practitioners; the degree of the staff is mainly undergraduate and the following, and the proportion of the graduate students and the above degree is below 10%, The total number of general practitioners in each unit is between 2 and 14. (1) In the service of health management, (1) In the health management service for the whole population, the rate of utilization of the electronic health archives and the qualified rate of the health archives is above 80%, but the utilization rate of the health files reaches only 50%; each institution has various forms of health education. And the updating times are more frequent. (2) In the health management service for the key population, all the indexes of the health management of the child and the pregnant women are above 90%, but the health management rate of the elderly is between 40% and 70%. (3) The standardized management rate of the patients with high blood pressure, diabetes and major mental illness is 7.64%-72.10%, 10.09-71.9% and 57.97% -100% in the health management service for the people with chronic diseases. (4) The service content and mode of each institution in the health detection and evaluation service, the health guidance and the intervention service are focused on each other. The Buyer's investigation and display:1. The validity of the questionnaire was analyzed. The coefficient of Cronbach's is more than 0.83, the overall Cronbach's coefficient is 0.901, the reliability is good, the KMO value is 0.887 (P0.001), the cumulative variance of each dimension is 69.659%, the structure validity is good, the correlation coefficient between the demand and the overall demand is 0.863-0.950, and the content validity is good. The coefficient of Cronbach's in each dimension of the questionnaire satisfaction evaluation part was greater than 0.85, the overall Cronbach's coefficient was 0.916, the reliability was good, the KMO value was 0.916 (P0.001), the cumulative variance interpretation rate of each dimension was 87.992%, the structural validity was good, the correlation coefficient between the satisfaction degree and the overall satisfaction degree was 0.764-0.939, The content validity is good. The health status of the investigated subjects: 13.2% of the respondents had a disease in the last two weeks, and 19.6% of the respondents had at least one chronic disease, and the self-evaluation of health status was in general (47.3%) and better (38.5%). The average score of overall demand and satisfaction for health management services was 3.88 and 3.63. Health management services know, utilization: 59.2% of the surveyed residents are aware of the health-file service, 53.2% of the surveyed residents are informed of the responsibility doctor service, and the top three of the health management services that have been received by the investigated residents are health check-ups (72.8%), respectively. Health files (35.4%) and health risk assessment services (20.4%).4. Health management service demand: the top three of the highest demand scores are health examination, health archives, and disease management services, respectively. According to the difference of the demand of health management in different areas, it was found that the health examination and evaluation of the population in the lower urban area were higher than that of the people in Jianggan district (P0.05). The knowledge of the responsibility physician service, the most frequent health management service organization, the medical insurance type, the satisfaction of the community health management service are the main influencing factors of the health management service demand of the residents. Satisfaction of health management service: The residents are most dissatisfied with the service frequency, service items and diagnosis and treatment equipment. There was no significant difference in the degree of satisfaction of the health management service in Jianggan district and the lower urban area (P0.05). The most frequent type of health management, the prevalence of chronic diseases and the need for health management services are the main influencing factors of the overall satisfaction of the community residents' health management service. The results of TOPSIS comprehensive evaluation showed that the comprehensive satisfaction of community health service center D was the highest, and the comprehensive satisfaction of center A was the lowest. Conclusion:1. The supplier's investigation conclusion. The human resource allocation of the community health service institutions is not reasonable, the education degree of the institution personnel is to be improved, the utilization rate of the health archives, the health management rate of the old people, the standard management rate of the hypertension and the diabetic patients is still low. The various agencies have provided a more unified and improved health management service project, but the contents of the health management service of the traditional Chinese medicine are still to be improved, and there is still a gap between the contents of the physical examination service, the health instruction and the way of health education. The buyer's investigation conclusion. The residents' demand for health management of the community is high, but the awareness of the health management related service items and the utilization of the health management services other than the regular medical examination are lower. The manager of the community health service institution shall take effective measures to improve the service content satisfaction of the service object, in particular the service frequency. Countermeasures and suggestions. It is suggested that the government department should strengthen the manpower guarantee, the financial support, the material supply and the policy support, and the community health service institution should strengthen the health management guided by the demand, adjust the service content in time, improve the service attitude and quality, strengthen the propaganda and supervision guidance, and attach importance to the construction of the talent team. Strengthen cooperation with the outside world, pay attention to the feedback and evaluation of the residents, and promote the benign development of the community health management service through the cooperation between the government and the community health service institution.
【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.61
，
本文编号：2483243
[Abstract]:Objective: To study the health management service of 6 community health service centers in Hangzhou, and to investigate the demand, utilization and satisfaction of community residents on the health management service and the main influencing factors. The countermeasures of the further development of the community health management service are put forward, and the reference basis for the community health management of the government and the community health service institution is provided. Method:1. Literature study. Through the review of the concept of health management and community health management service and the progress of its research and practice, the paper lays a theoretical foundation for exploring the present situation and the development of community health management service. Questionnaire design and research. The questionnaire was designed by means of literature reading, panel discussion and expert consultation, and six community health service centers were selected in the main urban area of Hangzhou by means of stratified random sampling. A self-designed questionnaire for community health management service in Hangzhou is used to investigate the basic conditions such as human, financial, material and service contents of the sample community health service center, and the self-designed health management service object needs are used. The survey of the residents who received the health management service was investigated by using the questionnaire of satisfaction survey, and 410 of the service objects were investigated. Data statistics and analysis. Using Epidata3.1 to set up the database and enter the data, the data was analyzed by using the SPSS10.0. The validity of the questionnaire, the factor analysis method and the Pearson correlation coefficient were used to check the validity of the questionnaire. The descriptive analysis, rank and test were used. The two-dimensional logistic regression analysis influences the evaluation factors of the satisfaction of the community residents' health management service. The TOPSIS analysis method is used to evaluate the health management service of the community health service center. Results: The supplier survey showed:1. in that aspect of personnel configuration, the number of the active staff of the investigated institution is relatively large, between 87 and 132, and the staffing of the personnel is the most in the number of medical practitioners; the degree of the staff is mainly undergraduate and the following, and the proportion of the graduate students and the above degree is below 10%, The total number of general practitioners in each unit is between 2 and 14. (1) In the service of health management, (1) In the health management service for the whole population, the rate of utilization of the electronic health archives and the qualified rate of the health archives is above 80%, but the utilization rate of the health files reaches only 50%; each institution has various forms of health education. And the updating times are more frequent. (2) In the health management service for the key population, all the indexes of the health management of the child and the pregnant women are above 90%, but the health management rate of the elderly is between 40% and 70%. (3) The standardized management rate of the patients with high blood pressure, diabetes and major mental illness is 7.64%-72.10%, 10.09-71.9% and 57.97% -100% in the health management service for the people with chronic diseases. (4) The service content and mode of each institution in the health detection and evaluation service, the health guidance and the intervention service are focused on each other. The Buyer's investigation and display:1. The validity of the questionnaire was analyzed. The coefficient of Cronbach's is more than 0.83, the overall Cronbach's coefficient is 0.901, the reliability is good, the KMO value is 0.887 (P0.001), the cumulative variance of each dimension is 69.659%, the structure validity is good, the correlation coefficient between the demand and the overall demand is 0.863-0.950, and the content validity is good. The coefficient of Cronbach's in each dimension of the questionnaire satisfaction evaluation part was greater than 0.85, the overall Cronbach's coefficient was 0.916, the reliability was good, the KMO value was 0.916 (P0.001), the cumulative variance interpretation rate of each dimension was 87.992%, the structural validity was good, the correlation coefficient between the satisfaction degree and the overall satisfaction degree was 0.764-0.939, The content validity is good. The health status of the investigated subjects: 13.2% of the respondents had a disease in the last two weeks, and 19.6% of the respondents had at least one chronic disease, and the self-evaluation of health status was in general (47.3%) and better (38.5%). The average score of overall demand and satisfaction for health management services was 3.88 and 3.63. Health management services know, utilization: 59.2% of the surveyed residents are aware of the health-file service, 53.2% of the surveyed residents are informed of the responsibility doctor service, and the top three of the health management services that have been received by the investigated residents are health check-ups (72.8%), respectively. Health files (35.4%) and health risk assessment services (20.4%).4. Health management service demand: the top three of the highest demand scores are health examination, health archives, and disease management services, respectively. According to the difference of the demand of health management in different areas, it was found that the health examination and evaluation of the population in the lower urban area were higher than that of the people in Jianggan district (P0.05). The knowledge of the responsibility physician service, the most frequent health management service organization, the medical insurance type, the satisfaction of the community health management service are the main influencing factors of the health management service demand of the residents. Satisfaction of health management service: The residents are most dissatisfied with the service frequency, service items and diagnosis and treatment equipment. There was no significant difference in the degree of satisfaction of the health management service in Jianggan district and the lower urban area (P0.05). The most frequent type of health management, the prevalence of chronic diseases and the need for health management services are the main influencing factors of the overall satisfaction of the community residents' health management service. The results of TOPSIS comprehensive evaluation showed that the comprehensive satisfaction of community health service center D was the highest, and the comprehensive satisfaction of center A was the lowest. Conclusion:1. The supplier's investigation conclusion. The human resource allocation of the community health service institutions is not reasonable, the education degree of the institution personnel is to be improved, the utilization rate of the health archives, the health management rate of the old people, the standard management rate of the hypertension and the diabetic patients is still low. The various agencies have provided a more unified and improved health management service project, but the contents of the health management service of the traditional Chinese medicine are still to be improved, and there is still a gap between the contents of the physical examination service, the health instruction and the way of health education. The buyer's investigation conclusion. The residents' demand for health management of the community is high, but the awareness of the health management related service items and the utilization of the health management services other than the regular medical examination are lower. The manager of the community health service institution shall take effective measures to improve the service content satisfaction of the service object, in particular the service frequency. Countermeasures and suggestions. It is suggested that the government department should strengthen the manpower guarantee, the financial support, the material supply and the policy support, and the community health service institution should strengthen the health management guided by the demand, adjust the service content in time, improve the service attitude and quality, strengthen the propaganda and supervision guidance, and attach importance to the construction of the talent team. Strengthen cooperation with the outside world, pay attention to the feedback and evaluation of the residents, and promote the benign development of the community health management service through the cooperation between the government and the community health service institution.
【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.61
，
本文编号：2483243
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