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朱晓磊, 张晓畅, 司向, 殷召雪, 马吉祥, 翟屹. 村医慢性病管理工作能力分析[J]. 中国公共卫生, 2019, 35(5): 622-625. DOI: 10.11847/zgggws1122693
引用本文: 朱晓磊, 张晓畅, 司向, 殷召雪, 马吉祥, 翟屹. 村医慢性病管理工作能力分析[J]. 中国公共卫生, 2019, 35(5): 622-625. DOI: 10.11847/zgggws1122693
Xiao-lei ZHU, Xiao-chang ZHANG, Xiang SI, . Capability in noncommunicable diseases management among village doctors in China[J]. Chinese Journal of Public Health, 2019, 35(5): 622-625. DOI: 10.11847/zgggws1122693
Citation: Xiao-lei ZHU, Xiao-chang ZHANG, Xiang SI, . Capability in noncommunicable diseases management among village doctors in China[J]. Chinese Journal of Public Health, 2019, 35(5): 622-625. DOI: 10.11847/zgggws1122693

村医慢性病管理工作能力分析

Capability in noncommunicable diseases management among village doctors in China

  • 摘要:
    目的 了解参与国家基本公共卫生服务慢性病患者(高血压和糖尿病)管理项目的村医工作现状。
    方法 2015年9月,在全国东中西部共选择8个省/自治区,每个省/自治区分别选择1个市,每个市选择1个县,每个县随机抽取3个乡镇卫生院共24个乡镇卫生院,对其下辖村卫生室中参与基本公共卫生服务慢性病患者管理的村医进行面对面问卷调查。调查内容包括人口学基本情况、参与慢性病管理情况、培训情况、工作困难和满意度等。使用SAS 9.4软件进行统计分析。
    结果 2015年调查266名村医,其中78.71 % 为兼职从事慢性病管理工作;平均每名村医管理慢性病患者人数(中位数)为189人,而认为可以管理的人数(中位数)为100人;有75.71 % 村医处于超负荷工作;所有村医都接受过高血压和糖尿病管理培训;调查村医中面临的主要困难是基层药物不能满足患者需求,占43.94 %,其次是患者依从性不高(38.64 %);村医对工资待遇、绩效考核和发展前景的满意度不高;多因素logistic回归分析显示,兼职(OR = 0.409,95 % CI = 0.169~0.988)以及受到惩罚(OR = 0.198,95 % CI = 0.088~0.449)更容易对工作不满意。
    结论 村医接受慢性病管理相关培训比例较高,但面临超负荷工作、患者依从性不高和基层药物不足等问题;应合理配置医疗卫生资源、因地制宜改善绩效考核制度,加快村医的队伍建设和提高专业能力。

     

    Abstract:
    Objective To examine village doctors′ performance in management of hypertension and diabetes – two major noncommunicable diseases (NCDs) patients covered by national primary public health service.
    Methods We first selected all village clinics under the administration of 3 township hospitals in one county in each of 8 provinces/autonomous regions in eastern, central, and western China; then we conducted a face-to-face questionnaire survey among village clinic doctors engaged in management on NCDs patients covered by national primary public health service in September 2015 to collect information on the doctors′ demographics, professional performance, trainings, and difficulty in and satisfaction to their work. SAS 9.4 software was used in statistical analysis.
    Results Of the 266 village doctors surveyed, 78.71% were part-timers. The median for the reported number of NCDs patients under the management of one village doctor was 189 and the median for number of NCDs patients which could be effectively managed by one village doctor was 100 based on the reporting of the village doctors surveyed. Of all the village doctors, 75.71% considered themselves being overloaded in the management work and all reported participations in trainings on hypertension and diabetes management. Main difficulties in NCDs patients management indicated by the village doctors were the lack of medicine supplied by grassroots clinics to meet the requirements of patients (reported by 43.94% of the doctors) and the patients′ poor compliance (38.64%). Low satisfaction to salary, performance assessment and career prospect were reported by the village doctors. Multivariate logistic regression analysis revealed that being a part-timer and being subject to administrative punishment were risk factors for overall satisfaction to working on NCDs patients management among the village doctors, with the odds ratios (95% confidence interval) of 0.409 (0.169 – 0.988) and 0.198 (0.088 – 0.449).
    Conclusion The village doctors′ management on NCDs patients is supported with professional training but hindered by overload work, poor compliance of patients, and lack of medicine supplied by grassroots clinics. Targeted measures are needed to promote the village doctors′ management on patients with NCDs.

     

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