摘要
在开启全面建设社会主义现代化国家新征程中,如何衡量及提升西部地区以基层为重点的医疗卫生服务质量,是践行“共建共享,全民健康”健康中国战略的关键内容。基层医疗卫生机构为当地居民提供常见病、多发病在内的基本医疗服务和预防保健在内的基本公共卫生服务,在降低卫生支出、分流就医患者、提高卫生服务体系效率方面发挥着重要作用。高质量的基层医疗卫生服务与更积极的出生结局、更长的预期寿命、更低的年龄调整死亡率、更低的可避免死亡率、更少的可避免住院治疗和更好的自我报告健康状况之间具有普遍的一致性。然而,当前西部地区基层医疗卫生服务仍存在服务有效性水平较低、处方合理性较差、医疗服务连续性不强等问题。基于中国基层卫生保健质量队列研究,通过匿名标准化患者方法,应用偏头痛、产后抑郁、小儿腹泻、普通感冒、胃炎、哮喘、心绞痛、腰背痛、压力性尿失禁、高血压、肺结核和糖尿病在内的11种匿名标准化患者病例,探索陕西省基层医疗卫生服务质量概况及提升策略。以社区卫生服务中心/站、乡镇卫生院、村卫生室、诊所/门诊部内的执业医师、执业助理医师、注册村医以及持有全科、内科、产科/妇科和儿科执照的临床医生为受访对象,采用多阶段分层整群抽样方法,在陕西省154家医疗机构对11种病例进行了259次访问。结果显示,陕西省基层医疗服务机构接诊医生问诊条目完成率为13.63%(8.33%,21.05%),检查条目完成率为6.25%(0,25.00%);访问中获得正确诊断次数为58次,占比27.36%;处置得分为0.49(0.33,0.70)分。PPPC-CN量表得分为2.38(2.12,2.76)分。USP候诊时间为4(1,10)分钟,就诊时间为7(5,10)分钟,就医总时间为15(10,25)分钟。USP就诊的总费用为12(0,45)元。总之,陕西省基层医疗服务质量的有效性、以患者为中心、及时性和效率均有较大的提升空间。相关部门应加快基层医疗信息化建设,构建基层临床路径以有效提高基层常见病、多发病的首诊能力,加强以患者为中心服务模式,实施综合培训模式以提升知识水平和实践能力,做好居民健康“守门人”。
In the new journey of comprehensively building a modernized socialist country,how to measure and improve the quality of healthcare services in the western region in China,with a focus at the primary level,is a key element in the implementation of the Healthy China Strategy,which is to“build and share health for all”.Primary healthcare institutions provide residents with basic medical services,including common and frequent diseases,and basic public health services,including prevention and they play an important role in reducing health expenditures,diverting patients,and improving the efficiency of the health service system.There is a general consistency between high-quality primary health care and more positive birth outcomes,longer life expectancy,lower age-adjusted mortality,lower avoidable mortality,fewer avoidable hospitalizations and better self-reported health status.However,the current primary healthcare services in the western region still suffer from low levels of service effectiveness,poor prescribing rationality,and poor continuity of healthcare services.Based on the China Primary Health Care Quality Cohort Study,11 unannounced standardized patient cases including migraine,postpartum depression,paediatric diarrhoea,common cold,gastritis,asthma,angina pectoris,lumbar back pain,stress urinary incontinence,hypertension,tuberculosis and diabetes mellitus were developed through the unannounced standardized patient approach to explore the quality profile of primary healthcare services in Shaanxi Province and the enhancement strategies.With practicing physicians,practicing assistant physicians,registered village doctors,and clinicians holding licenses in general practice,internal medicine,obstetrics/gynecology,and pediatrics within community health service centers/stations,township health hospitals,village health offices,clinics/outpatient clinics as the target respondents,259 interviews were conducted in 154 healthcare facilities in Shaanxi Province for 11 types of cases,using a multi-stage,stratified,whole cluster sampling method.The results showed that the completion rate of questioning entries for physicians receiving primary care services in Shaanxi Province was 13.63%(8.33%,21.05%),and the completion rate of examination entries was 6.25%(0,25.00%);the number of times a correct diagnosis was obtained during the visit was 58,occupied 27.36%;the disposition score was 0.49(0.33,0.70).The PPPC-CN scale score was 2.38(2.12,2.76).the USP wait time was 4(1,10)minutes,the visit time was 7(5,10)minutes,and the total time of wait and visit was 15(10,25)minutes.the total cost of the USP visit was 12(0,45).In conclusion,the effectiveness,patient-centeredness,timeliness and efficiency of primary healthcare services in Shaanxi Province have much room for improvement.Relevant departments should accelerate up the construction of primary care information technology,build clinical pathways for primary care to effectively improve the ability of primary care to provide first diagnosis for common and frequent diseases,strengthen the patient-centered service model,implement an integrated training model to enhance knowledge and practical skills,and do a good job as the‘gatekeeper'of residents'health.
作者
周忠良
范小静
ZHOU Zhongliang;FAN Xiaojing(School of Public Policy and Administration,Xi'an Jiaotong University,Xi'an 71o049,China)
出处
《西安交通大学学报（社会科学版）》
CSSCI
北大核心
2023年第6期188-200,共13页
Journal of Xi'an Jiaotong University：Social Sciences
基金
国家社会科学基金重大项目(20&ZD121)。
关键词
健康中国
基层医疗
公共卫生
服务质量评价
居民健康
Healthy China Strategy
primary health care
public health
service quality evaluation
resident health
