Involvement in integrated basic medical care and basic public health services among medical personnel in Guangzhou city: a cross-sectional survey
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摘要:
目的 了解广东省广州市基本医疗和基本公共卫生融合情况,为进一步推进广州市医防融合提供科学依据。 方法 于2019年12月 — 2020年1月采用便利抽样方法抽取广州市11个区开展国家基本公共卫生服务项目工作的7416名基层医疗卫生机构医务人员进行网络问卷调查。 结果 广州市最终有效调查的7305名基层医务人员中,1148人(15.72 %)仅从事基本医疗,2713人(37.14 %)仅从事基本公共卫生,3444人(47.15 %)存在基本医疗和基本公共卫生融合。3444名基本医疗和基本公共卫生融合人员中,融合1项者541人(15.71 %),融合2~4项者1164人(33.80 %),融合5~7项者1012人(29.38 %),融合 ≥ 8项者727人(21.11 %);居于基本医疗和基本公共卫生融合前3位的国家基本公共卫生服务项目依次为健康教育2522人(73.23 %)、居民健康档案管理2428人(70.50 %)和高血压患者健康管理2201人(63.91 %)。广州市不同特征基层医务人员比较,不同辖区、性别、职业、医疗机构类别和是否全科医师的基层医务人员基本医疗和基本公共卫生融合情况差异均有统计学意义(均P < 0.001),其中非中心城区融合高于中心城区,男性融合高于女性,职业以临床医师融合最高、公卫医师融合最低,医疗机构类别以村卫生室融合最高、社区卫生服务站融合最低,全科医师融合高于非全科医师。 结论 广州市基本医疗和基本公共卫生融合较好的国家基本公共卫生服务项目为健康教育、居民健康档案管理和高血压患者健康管理,但应重视在中心城区、女性、公卫医师、社区卫生服务站和非全科医师中的融合。 Abstract:Objective To examine the involvement in integrated basic medical care and basic public health services among medical staff in Guangzhou city, Guangdong province and to provide evidences for promoting the integration of medical care and public health in the city. Methods Using convenience sampling and a self-designed questionnaire, we conducted an online anonymous survey among 7 416 grassroots medical staff in community/town health care institutions and village clinics covered by National Basic Public Health Service Project in 11 districts of Guangzhou city from December 2019 to January 2020. Results Among the 7 305 participants with valid responses, 1 148 (15.72%) and 2 713 (37.14%) reported being engaged only in basic medical care and only in basic public health service; while, 3 444 (47.15%) reported being engaged in both basic medical care and basic public health service, of which, 541 (15.71%), 1 164 (33.80%), 1 012 (29.38%), and 727 (21.11%) were involved in one, 2 – 4, 5 – 7, and 8 or more integrated items of basic medical care and public health service, respectively. Reported by the participants, the top three integrated service items covered by National Basic Public Health Service Project were health education (reported by 2 522 [73.23%] of the participants), residents′ health record management (2 428 [70.50%]), and hypertensives′ management (2 201 [63.91%)]. The reported proportion of being engaged in the integrated service items differed significantly by living residence, gender, occupation, category of medical institution, and whether being general practitioners (all P < 0.001); the participants not living in central urban regions, being male, being clinicians, working in village clinics, and being general practitioners reported a higher proportion compared to those reported by the participants living in central urban regions, being female, being public health doctors, working in community health care centers, and being medical personnel other than general practitioners. Conclusion In Guangzhou city, the majority of grassroots medical staff were involved in integrated service items of health education, resident health records management, and hypertension patients management covered by National Basic Public Health Service Project. The participation of integrated medical care and public health services should be promoted among grassroots medical staff working in central urban regions, being female, being public health doctors, working in community health care centers, and being medical personnel other than general practitioners. -
Key words:
- basic medical care /
- basic public health /
- integration
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表 1 广州市不同特征基层医务人员基本医疗和基本公共卫生融合情况比较
特征 调查数 基本医疗和基本公共卫生融合 χ2 值 P 值 人数 % 辖区 a 非中心城区 4211 2207 52.41 110.583 < 0.001 中心城区 3094 1237 39.98 性别 男性 1764 932 52.83 30.202 < 0.001 女性 5541 2512 45.33 职业 临床医师 2338 1610 68.86 1221.327 < 0.001 公卫医师 1099 64 5.82 护士 2545 1185 46.56 医技人员 513 248 48.34 药师 528 246 46.59 后勤及管理人员 282 91 32.27 医疗机构类别 社区卫生服务中心 4829 2157 44.67 156.405 < 0.001 社区卫生服务站 96 35 36.46 镇卫生院 b 2243 1120 49.93 村卫生室 137 132 96.35 全科医师 否 5237 2040 38.95 498.230 < 0.001 是 2068 1404 67.89 注:a 中心城区为越秀、海珠、荔湾、天河和白云5个区,非中心城区为番禺、黄埔、花都、增城、从化和南沙6个区;b 包括1家区属医院的39人。 -
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