医养结合模式下社区卫生服务中心服务内容探讨——基于上海市嘉定区医养结合服务内容供需方调研

发布时间：2018-05-06 23:26

本文选题：社区卫生服务 + 医养结合　；参考：《中国全科医学》2017年24期

【摘要】：目的了解区域内养老机构的住养老人医疗服务需求、医养结合团队的服务提供能力,为进一步厘定服务内容、开展医养结合服务工作奠定基础,也为医养结合服务内容的厘定路径提供参考。方法 2016年11—12月,以上海市嘉定区3家养老机构的住养老人作为需方研究对象、10家嘉定区社区卫生服务中心及上海市嘉定区迎园医院的医养结合团队医护人员作为供方研究对象,开展医养结合服务内容供需方调研工作。问卷主要包括供需方基本情况、7类医养结合服务项目的需方需求/供方服务提供能力,分析需方需求程度(非常高、较高、一般)、供方服务提供能力(较高、一般、较低)。结果需方调查表的Cronbach's α系数为0.980;供方调查表的Cronbach's α系数为0.966。养老机构中住养老人对7类医养结合服务项目的总体需求程度为73.23%~96.80%,其中总体需求程度最高的是健康体检(96.80%),其次是健康促进管理(94.98%),最低的是慢病管理(73.23%)。单项服务项目需求程度为54.20%~98.70%,其中后3位是慢病管理中的肿瘤患者的建卡(54.20%)、随访(55.10%)及访视与康复指导(55.10%)。医养结合服务团队的总体服务提供能力为50.00%~89.24%,其中总体服务提供能力最高的是护理服务(89.24%),其次是其他服务(88.09%),后2位则是康复服务(50.00%)和临床诊疗(70.85%)。单项服务项目服务提供能力为42.62%~100.00%,其中后3位是临床诊疗的突发状况临时查房(严重程度-重度)(42.62%)、护理服务的创伤清创包扎(大)(44.44%)及健康体检的B超(47.54%)。7类服务项目中,单项服务项目需求非常高且服务提供能力较高的主要为健康促进管理(4/6,66.67%)、健康体检(7/13,53.84%)、其他服务(5/8,62.50%);单项服务项目需求较高或非常高且服务提供能力较高的是护理服务(11/16,68.75%);单项服务项目需求非常高但服务提供能力一般或较低的主要是临床诊疗(6/12,50.00%);单项服务项目需求较高或一般,但服务提供能力一般或较高的主要是慢病管理(13/14,92.86%);单项服务项目需求较高,但服务提供能力较低的则是康复服务(21/21,100.00%)。结论受服务提供能力限制,社区卫生服务中心可为老年人优先提供健康促进管理、护理服务、慢病管理和健康体检服务,社区卫生服务中心应重点加强康复服务和临床诊疗的服务提供能力,最终逐步开展围绕老年人的全生命周期的健康管理。
[Abstract]:Objective to understand the medical service demand of the elderly living in the regional pension institutions and the ability of the medical support team to provide service, so as to lay a foundation for the further determination of the service content and the development of the medical and nursing service. It also provides a reference for the determination of the content of the combination of medical and nursing services. Methods from November to December 2016, Taking the elderly living in 3 pension institutions in Jiading District of Shanghai as the object of study, 10 community health service centers in Jiading District and the medical and nursing team of Yingyuan Hospital in Jiading District of Shanghai were taken as the research objects. To carry out research on the supply and demand side of the combined medical and nursing services. The questionnaire mainly includes the demand-side demand / supply-side service supply ability of 7 kinds of medical-support combination service items, and analyzes the demand-side demand degree (very high, general, supply-side service providing ability) (higher, general, lower). Results the Cronbach's 伪 coefficient of the demand-side questionnaire was 0.980, and the Cronbach's 伪 coefficient of the supplier questionnaire was 0.966. The total demand for 7 kinds of medical and nursing service items in old-age institutions was 73.230.96. 80, among which the highest degree of demand was health examination, the second was health promotion management (94.98), and the lowest was chronic illness management (73.2335). The demand level of single service item was 54.20 and 98.70, among which the latter three were the 54.20m of the patients with chronic diseases, followed up 55.1010g), and the visiting and rehabilitation guidance 55.1010. The overall service provision ability of the medical and nursing service team was 50.009. 24%, among which the overall service providing ability was the highest in nursing service 89.24, followed by other services 88.090.0910, and the latter two were rehabilitation service 50.005) and clinical diagnosis and treatment 70.85. The service delivery capacity of a single service item is 42.62 / 100.00.Of these, the latter three are temporary rounds of clinical emergency status (severity-severe, 42.62%), debridement and bandage of nursing services (Dachuang 44.44), and health examination of B ultrasound and 47.54.7 types of services. Those with very high demand for single service items and high service delivery capacity are mainly health promotion management 4 / 6 / 66.67, health checkup 7% 1353.84, other services 5 / 8 62.50; single service items with high or very high demand and high service delivery capacity are nursing services. 11 / 16 / 68.75%; the demand for a single service item is very high, but the service delivery capacity is generally or relatively low, mainly for the clinical diagnosis and treatment of 6 / 12 / 12 / 50.00. the single service item has a high or average demand. However, the average or higher service delivery capacity is mainly chronic illness management 13 / 1492. 86%; the demand for individual service items is higher, but the lower service delivery capacity is the rehabilitation service 21% 21100.000. Conclusion the community health service center can give priority to health promotion management, nursing service, chronic disease management and health examination for the elderly. The community health service centers should focus on strengthening the ability of providing rehabilitation services and clinical diagnosis and treatment services, and finally gradually develop the health management around the whole life cycle of the elderly.
【作者单位】：上海市嘉定区南翔镇社区卫生服务中心;上海市嘉定区第一社会福利院;上海市嘉定区南翔镇福利院;上海市嘉定区南翔镇永乐村养老院;
【基金】：上海市卫生和计划生育委员会面上资助项目(201540338) 上海市嘉定区科学技术委员会资助项目(2015015)
【分类号】：D669.6;R197.1

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