【作者】 曹颖；

【导师】 何钦成；

【作者基本信息】 中国医科大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 目的只有了解居民的社区卫生服务需要、需求和利用情况,才能为社区卫生服务工作的宏观管理和科学决策提供客观依据。因此本论文旨在通过收集现场资料并通过多种统计学方法分析,全面了解沈阳市城郊四区居民对社区卫生服务的需求和利用情况,影响需求、利用情况的因素以及居民、患者对社区卫生服务的满意程度,期望以此为管理者提供科学的决策依据,促进资源的合理配置、充分利用,使社区卫生服务健康发展,更好地满足居民的卫生服务需求,真正成为解决卫生问题的重要手段之一。材料和方法本研究通过问卷调查法对所调查地区的社区卫生服务中心覆盖的居民和就诊的患者进行调查,了解居民的社会人口学特征、两周患病和慢性病患病情况、住院情况、患病时的择医取向,居民对社区卫生服务的知晓、需求及利用情况,就诊患者对社区卫生服务的满意情况,以此来分析影响居民对社区卫生服务利用以及满意度的因素。本研究采用了文献检索法、现场问卷调查法、描述性分析法对所调查地区社区卫生服务进行了调查分析,运用了行乘列表的X²检验、成组设计多个样本的秩和检验、非条件Logistic回归分析、最优尺度分析、模糊综合评价等统计学方法进一步分析、评价了涉及社区卫生服务需求、利用和满意度的影响因素。结果研究表明,所调查地区按患病人数计算得到居民的两周患病率为18.29%,其中男性患病率为16.87%,女性患病率为19.58%。按人数计算居民的慢性病患病率为23.36%,其中男性患病率为24.41%,女性患病率为22.41%。两周就诊率为8.37%,其中男性为8.78%,女性为8.01%。两周未就诊率为54.26%,其中未就诊的主要原因是经济困难、病情不严重、自我医疗。居民一年内的住院率为8.57%,而未住院率为45%,未住院的主要原因是经济困难。居民在自感病轻时意向首选的就诊机构主要是自我医疗、社区卫生服务中心、区级医院,在自感病重时意向首选的的就诊机构主要是省级医院、市级医院、区级医院。居民首选社区卫生服务中心就诊的主要原因是方便快捷,服务态度好,价格适宜;而不首选的主要原因是对社区卫生服务中心的技术水平不放心,不了解社区卫生服务,对社区卫生服务中心的设施、设备不满意。在过去的一年中,有499人去过社区卫生服务中心,利用率为32.38%。采用非条件Logistic回归分析和最优尺度分析两种方法对影响社区卫生服务中心利用情况的因素进行分析。非条件Logistic回归分析的结果显示:工作情况为下岗和退休,人均年收入在2000-8000元,患有慢性病,知道家附近有社区卫生服务中心,知道社区卫生服务中心的服务时间,患病后首选社区卫生服务中心,听过社区卫生服务中心的知识讲座的居民更倾向于利用社区卫生中心。集体所有制,举办主体为二级和三级医院,全科医学培训比例高的,服务项目开展率高的,门诊平均处方费用低的社区卫生服务中心更能吸引群众就诊。最优尺度分析的结果显示:年龄,文化程度,工作情况,人均年收入,是否患慢性病,知道家附近有社区卫生服务中心及服务时间,病轻病重时的就诊机构,患病后会首选社区卫生服务中心,听过社区卫生服务中心的知识讲座的居民,社区卫生服务中心的所有制、举办主体、中心建筑面积、高级职称的比例、培训比例、服务项目开展率、门诊平均处方费用,门急诊次均费用都是影响社区卫生服务利用的因素。利用模糊综合评价方法分析就诊患者对社区卫生服务中心的满意度情况。当权重为等权时,模糊评价总评分J₁为48.88;当权重不等时,模糊评价总评分J₂为64.982。结论1、所调查地区卫生服务需求的重点人群是老年人、文化程度低、经济收入低和患有慢性病的人群。2、居民卫生服务的需要应进一步向需求转化。3、居民对社区卫生服务利用率较低,认识不足,并且需求项目和实际利用的项目存在差异。4、患者对社区卫生服务中心尚介于很不满意到一般满意的状态,对中心的设备及价格不满意的比重较大。5、对影响社区卫生服务的供需方因素分析的结果提示,社区卫生服务中心要开展社区诊断,确定重点人群,加大全科医生的培训比例,完善医务人员的职称结构,提高技术水平。同时,政府也应加强对社区卫生服务中心的政策指导和资金投入,并将服务价格控制在合理的范围。更多还原

【Abstract】 We can provide a strong objective basis for macroeconomic management and scientific decision-making of community health service by understanding the residents’ needs, demand and utilization of community health service. The paper, by collecting the data in four Suburbs of shenyang and using some statistical methods, aims to investigate people’s demand and utilization of community health service, analyze the effective factors and evaluate patients’ satisfaction to the community health service. It is also espected that the thesis can supply a scientific evidence for manager to formular policy, allocate resource reasonably, make the community health service better than before, meet the health service need of residents, make community health service become one of the most important methods to resolve the health problem.MethodsThe paper makes use of questionnaire survey to investigate the residents and patients of community health service centers in four suburbs of shenyang ,and to find out the social demography character, two-week sickness condition and chronic-sickness condition one half year before the investigation、the hospitalization utilization condition one year before the investigation, the intension of hoapital chosen will choose, the awareness to the community health service, residents’ needs and utilization to the community health service , the patients’ satisfaction degree. The factors were analysed which can affect residents’ utilization of community health service and patients’ satisfaction degree to community health service on the basis of the study.Document retrieval, field survey and descriptive analysis were employed to investigate and analyze the community health service in four districts of one city in Liaoning province, crosstable Chi-square test, kruskl-wallis H, non-condition logistic regression, optimal-scaling, vague comprehensive estimation were used in the process of document and data analysis.ResultsThe results indicate that: the residents’ prevalence of sickness in two week computed by patients is 18. 29% (the male’s is 16. 87%; the female’s is 19.58%). Their chronic diseases prevalence also computed by patients is 23. 56% (the male’s is 24. 41%, the female’s is22.41%). The two -week consultation rate is 8.37% (the male’s is 8. 78%; the female’s is 8. 01%). The ratio of those who should visit a doctor but not is 54.26% and the main reasons are lack of money, the unserious sickness, and self-cure. The hospitalization rate is 8. 57%, the rate of those should be hospitalized but fail to do so is 45%, and the main reason is lack of money. As for the choice of health organization to visit, if one is suffering from a minor disease, he will go to the drug store and buy some drugs, or to community health service, or to the district hospital, but if suffering from serious disease, he will go to the secondary or tertiary hospitals for treatment. The main reasons for choosing community health service are convenient, better attitude, and rational price. The main reasons for not choosing are as follows: residents do not believe the technical competence, and not understand the community health service, and not satisfy with the installations. In the last year, 499 residents went to community health service in this study, and the rate is 32. 38%.The factors of effecting the utilization of community health service were analyzed with the methods of non-condition logistic regression and optimal-scaling. The result of non-condition logistic regression includes that: the residents who have been retied or laid off, and whose income pre-year is between 2000 and 8000 RMB, and who have chronic disease, and who know there is community health service near home and know the service time, and who choose community health service when they are uncomfortable, and who have listened the lectures hosted by community health service tend to choose community health service. The community health service that is collective ownership, and held by better hospital, and higher rate of general medicine training, and higher rate of supplying services, and lower-cost of average prescription can attract more patients. The final factors of optimal scaling includes that: the residents’ age, culture level, job, income per-year, suffering from chronic disease, knowing the community health service nearby, patients’ choose of hospital, residents’ intension of choosing community health services having listened the lectures hosted by community health service, CHS’ system ownership, principal part of conduct, construction area, the rate of senior title, the rate of general medicine training, the rate of supplying services, the price of average clinic prescription, the average expense of clinic and emergency.The paper analyzes the satisfaction degree with the community health service in the method of vague comprehensive estimation. When the weights are equal, the unsatisfaction degrees sorting from big to small are staffs’ attitudes, the convience community helth services, waiting time for seeing a doctor, technical competence.Conclusions1. The groups whichmost need community health service in four Suburbs of ShenYang are older residents、less educated residents、poor residents and redidents suffering from chronical illness.2. The demand for health care should converse to the need gradually.3. The utility of community health service is not very welldue to the less understanding of community health service, and there is a unlikeness between needs and actual utility.4. The patients’ satisfaction to the community health service varried from very dissatisfied degree to generally satisfy degree, the most unsatisfaction are the equipment and the price.5 . Through analyzing the demanding and supplying factor of impacting community health service, it is conclude that: we should develop the community diagnosis, and determine the key residents’ group of service, and intensify the training ratio of general practitioners, and strenghten the technicallevel. At the same time, the government should also strengthen policy guidances’ input funds to the community health service, and control the service price withen reasonable bounds.更多还原