摘要
背景 基层医疗卫生机构推广中医药适宜技术是“中西医并重”的一项重要工作,也是推动中医药传承与发展的重要行动。目的 分析基层卫生技术人员使用中医药适宜技术的偏好,为中医药适宜技术在基层医疗卫生机构的推广与使用提供政策建议。方法 于2021年7—8月,采用多阶段随机整群抽样的方法,在我国东、西部抽取共23家基层医疗卫生机构,纳入当天在岗的卫生技术人员319例进行问卷调查。319份问卷中295份通过一致性检验,问卷有效率为92.5%。本研究离散选择模型问卷共纳入7个属性,采用高效正交设计,获得18个选择集,并均匀地分为3个问卷版本,每个版本的问卷包括6个选择集(含退出选项)及1个一致性检验题。此外,还调查了基层卫生技术人员基本信息,包括性别、年龄、受教育水平、专业技术职称等。采用条件Logit模型和潜在类别模型对基层卫生技术人员中医药适宜技术使用进行偏好分析。采用支付意愿将属性水平变动后基层卫生技术人员效用的变化进行货币化展示。结果 条件Logit模型中,是否在医疗保险范围内、单次操作时长、对收入的影响、对工作负担的影响、对职称(岗位)晋升的帮助、技术疗效、对患者支出的影响均对卫生技术人员中医药适宜技术使用偏好存在影响(P<0.05)。潜在类别模型显示,中医药适宜技术观望类(16.2%)退出选项系数为-3.660(P<0.001),中医药适宜技术支持类(83.8%)退出选项的系数为2.189(P<0.001)。中医药适宜技术观望类更愿意使用可提升疗效的中医药适宜技术(β=1.275),中医药适宜技术支持类对使用疗效不变的技术无明显偏好(β=0.054)。结论 基层卫生技术人员更偏好使用能够增加收入、保持工作负担不变、减少或保持患者费用、有助于晋升、在医疗保险范围内且疗效更优的中医药适宜技术,推动中医药适宜技术进入医保报销目录、将中医药适宜技术使用与技术人员晋升制度挂钩能够有效提高基层卫生技术人员使用中医药适宜技术的积极性,对不同类的卫生技术人员应采取差异化激励手段。
Background The promotion of appropriate traditional Chinese medicine(TCM)techniques in primary care institutions is an important measure emphasizing the co-development of Chinese and western medicine,and enhancing the inheritance and development of TCM.Objective To analyze primary health workers'preferences for the use of appropriate TCM techniques,providing policy recommendations for the promotion and use of such techniques in primary healthcare institutions.Methods This questionnaire survey was conducted between July and August 2021.A discrete choice model with seven attributes and 18 choice sets obtained through the use of an efficient orthogonal design were used to develop the questionnaire used in the survey,and the questionnaire has three versions each version with evenly allocated six choice sets(including an opt-out option).Additionally,the three versions have a common general demographic part(sex,age,education level,professional title,etc.)and one common consistency test question.A randomized multistage stratified cluster sampling was used to select 319 health workers on duty on the survey day from a total of 23 primary healthcare institutions in three counties in eastern,central and western China(one county was extracted from each region),and each worker was required to complete one version of the questionnaire extracted sequentially by themselves.Two hundred and ninety-five cases who returned a questionnaire passing a consistency test were included for analysis,resulting in a response rate of 92.5%.Primary health workers'preferences for appropriate TCM techniques were analyzed using conditional Logit models and latent class models.Furthermore,the changes in utility of primary health workers due to attribute level changes were monetized using willingness to pay and presented accordingly.Results The conditional Logit analysis showed that medical insurance,the average duration of each operation with the TCM technique,the influence of operation with the TCM technique on income,work burden,the promotion of professional title,and patient healthcare cost,as well as effectiveness of the TCM technique were associated with primary health workers'preferences for the use of appropriate TCM techniques(P<0.05).The latent class model revealed that the opt-out option coefficient for those holding a wait-and-see attitude toward the use of TCM techniques(16.2%)was-3.660(P<0.001),while that for those supporting the use of TCM techniques(83.8%)was 2.189(P<0.001).Moreover,those holding a wait-and-see attitude toward the use of techniques exhibited a stronger preference for appropriate TCM techniques that have been proven to be more efficacious(β=1.275),and those supporting the use of TCM techniques showed no significant preference for those with unchangeable effectiveness(β=0.054).Conclusion Primary health workers prefer to use appropriate TCM techniques that can increase their income without workload increase,facilitate their professional title promotion,retain or reduce patient costs,and are covered by health insurance and have good efficacy.To effectively promote primary health workers'enthusiasm in the use of appropriate TCM techniques,it is suggested to add these techniques to the medical insurance reimbursement list,and make a connection between the use of these techniques and title promotion.In addition,different incentive strategies should be adopted for different types of primary health workers.
作者
严豪
陈思思
聂瀚林
黄正伟
胡寒旭
赵伟菡
杨勇
石学峰
YAN Hao;CHEN Sisi;NIE Hanlin;HUANG Zhengwei;HU Hanxu;ZHAO Weihan;YANG Yong;SHI Xuefeng(School of Management,Beijing University of Chinese Medicine,Beijing 100029,China;Medical Device Regulatory Research and Evaluation Centre,West China Hospital,Sichuan University,Chengdu 610044,China)
出处
《中国全科医学》
CAS
北大核心
2023年第16期1958-1964,共7页
Chinese General Practice
基金
国家自然科学基金资助项目(7207040925)——基于离散选择实验的中医药适宜技术扩散机制研究。
关键词
中医药疗法
社区卫生服务
社区卫生工作者
偏好研究
离散选择实验
条件Logit回归分析
潜在类别分析
Traditional Chinese medicine therapy
Community health services
Community health workers
Preference
Discrete choice experiment
Conditional logistic regression analysis
Latent class analysis
