【作者】 康殿巨；

【导师】 白亚娜； 刘元强；

【作者基本信息】 兰州大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 目的评价2项目县中医适宜技术培训效果,分析中医适宜技术培训效果影响因素;进行中医适宜技术推广效果评价;探讨适宜技术有效的推广模式,为适宜技术的进一步推广提供科学依据。方法(1)中医适宜技术培训方法:采用集中培训的方式在兰州进行培训。(2)培训效果分析:①客观评价:以认知率和学习成绩作为效果评价指标;②主观评价:调查学员对培训的主观认知和满意度;(3)中医适宜技术培训效果影响因素分析:①学员的因素,分析学员的职称、学历、单位级别、专业等因素对培训效果的影响;②授课教师的因素:分析授课教师的职称对培训效果的影响。(4)中医适宜技术成本效果分析:①成本核算(C):计算培训总成本,并划分为直接成本和间接成本。②效果测量(E):以认知效果(认知提高幅度)、学习效果(成绩提高幅度)和满意效果(满意度)三个指标作为效果指标。③成本效果分析:成本-效果比(C/E)和增量的成本效果比作为分析指标,评价培训的投入和产出的关系。(5)推广效果研究:向医务人员调查中医适宜技术的使用情况;向患者调查适宜技术的疗效;向项目管理者、医生调查适宜技术推广的阻碍因素。结果(1)中医适宜技术培训效果:①客观效果。认知率:学员对中医技术认知率在培训前后有统计学差异(x~3=5.86,P＜0.05),培训前、讲授后、互动强化后分别为40.08%、71.71%、73.83%,共提高了33.75%。学员对单项技术在讲授后、强化后的认知率与培训前认知率均有统计学差异(P＜0.05)。学习成绩:学员对11项中医技术在培训前后得分变化均具有统计学意义(F=508.80,P＜0.01),培训前、讲授后、互动强化后分别为17.33、65.42、68.10,共提高了2.93倍。②主观认知效果。学员对各项中医适宜技术的需求情况、掌握程度和再培训需求情况的认知均具有统计学意义(P＜0.01),需求者占80.43%-100.00%,掌握者占84.78%-100.00%,再培训需求者占23.08%-48.08%。学员对各项中医适宜技术学习难易程度的认知具有统计学意义(Hc=46.15,P＜0.01),8.05%学员认为中医适宜技术很难学,57.49%学员认为中医适宜技术学习难度一般,34.46%学员分别认为中医适宜技术容易。学员对各期培训授课互动强化的满意度之间具有统计学意义(Hc=74.25,P＜0.01)。学员对中医技术培训的互动强化的满意度为97.83%-100%。(2)培训效果影响因素分析:①学员的因素:不同学历学员的培训成绩之间有差别(F=5.79,P＜0.01),其中本科及以上、大专分别与中专及以下有差别(P＜0.05),本科及以上与大专之间无差别(P＞0.05),即中专及以下者学习成绩最低。不同单位级别学员对中医技术培训的需求程度之间有相关性(τ=0.156,P＜0.01),单位级别越高对中医技术培训的需求越高,反之越低。不同单位学员对培训内容难易程度认知有统计学意义(P＜0.01),学员单位级别越高,认为中医技术培训内容难度越低。不同单位级别学员对技术持有单位专家授课的满意度有统计学意义(P＜0.05),县级的满意度高于乡级。不同职称(τ=-0.085,P＜0.05)、学历(τ=-0.016,P＜0.01)、单位级别(τ=-0.020,P＜0.01)、专业(Hc=12.512,P＜0.01)学员对技术再培训需求有统计学差异。学员职称越低、学历越低、单位级别越低对中医技术在再培训的需求越大,反之则需求越低。不同专业学员对知识掌握程度的主观认知有统计学意义(Hc=22.063,P＜0.01)。②授课教师的因素。职称:学员对不同职称授课教师的满意度之间无统计学差异(τ=0.072,P＞0.05)。92.02%学员对教师的授课满意,2.97%学员不满意。教师生源:学员对于技术持有专家授课的满意度(87.84%)高于本地专家(12.16%)。(3)成本效果分析:①成本核算:中医技术培训总成本225703.28元,其中直接成本169454.48元,间接成本元56248.80元。单项技术人均总成本在367.47—450.44元之间,人均直接成本在260.68—343.75元之间,人均间接成本在68.30—115.22元之间。②效果测量:单项技术认知效果在9.43%—52.00%之间;单项技术学习效果在11.43—70.18分之间,单项技术满意度在80.76%—100%之间。③成本效果分析:单项技术培训成本-认知效果比在7.22—38.97之间。单项技术培训成本-学习效果比在5.23—32.15之间。单项技术培训成本-满意效果比在80.76—100之间。中医技术培训的成本-学习效果比为35.20、。增量成本效果比为54.67。(4)推广效果研究:单项中医技术的使用率和有效率之间均有统计学差异(p＜0.01)。中医技术的使用率在11.11%—44.90%之间,有效率在87.64%—95.97%之间。结论(1)甘肃省中医适宜技术的培训工作取得了较好的效果。(2)培训效果受学员本身背景(职称、学历、单位级别、专业)、授课教师及生源等因素的影响。(3)培训方式是影响成本效果分析的重要因素,应根据适宜技术的特性、经费情况选择经济、有效的培训方式。(4)没有配套设备、器械和时间太短没有病人是中医技术未被使用的主要因素;推广经费不足和技术使用单位软硬件条件跟不上是阻碍中医技术推广的主要因素。(5)背景决定模式,模式支配机制,机制促进推广。我省中医技术适合政府扶植的推广模式。根据当地的实际情况、技术特性、县乡级别选择合理、有效的推广模式,促进适宜技术的推广应用。更多还原

【Abstract】 Objectives Evaluate the training effects and influencing factors of Appropriate Techniques of Traditional Chinese Medicine(ATTCM)in two counties of Gansu province.To study extension effects and model of ATTCM.This research can supply scientific evidences for further extension of ATTCM.Methods(1)Training way:To train the doctors by the way of gathered-trainlng pattern in Lanzhou city;(2)Evaluation on training effects:①objective evaluation:We used the cognition rates and average scores as the evaluation indexes.②subjective evaluation: Investigate subjective cognition and the satisfaction degree of the objects(3)Analysis of influencing factors:①factors of the trainees:analyze trainees’ titles,education backgrounds,hospital grades,majors:②factors of the teachers:Analyze Teacher’s Tile and source.(4)cost-effectiveness analysis:①cost accounting(C):Calculated Total Cost of training and divided it into direct and indirect cost.②measurement of effects (E):we used the cognitive effect(increase of cognition),average scores(increase of scores)and satisfaction effects(satisfaction degree)as the three evaluation indexes.③cost-effectiveness analysis:Cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio were analyzed to compare inputs with outputs of training.(5) promotion effects evaluation:Investigate service condition,efficacy of ATTCM,and explore hindering factors in promotion of ATTCM.Results(1)Training effects:①objective effects.Cognition rates:cognition rates of trainees towards 11 Chinese medicine techniques in pre-training,post-lecture and post-interaction are 40.08%,71.71%and 73.83%,respectively,and it has been improved by 33.75%.There was significant difference among them(χ2=5.86,P＜0.05). Average scores:Average scores of trainees at three training periods were 17.33、65.42、and 68.10,respectively,and it has been improved by 2.93 times,There was significant difference among them(F=508.80,P＜0.01).②subjective effects.Demand rate,grasp rate and retaining demand rate among trainees all had statistical significance.Demand rate was 80.43%-100.00%,grasp rate was 84.78%-100.00%, and demand rate of retaining was 23.08%-48.08%.trainees have statistical significance in The cognition of learning difficulty of techniques(Hc=46.15,P＜0.01). 8.05%,57.49%and 34.46%trainees thought it was difficult,medium and easy, respectively.They also have statistical significance in satisfaction degree of interaction reinforcement of each stages(Hc=74.25,P＜0.01).The satisfaction degree of interaction reinforcement was 97.83%-100%.(2)Influencing factors about training effects.①trainees’ factors:trainees who have different educational backgrounds had significant difference in scores(F=5.79,P＜0.01),trainees with secondary technical and lower education had lowest scores.There had Correlation between trainees’ grade of hospital and demand rates(τ=0.156,P＜0.01),The higher trainees’ grade were,the greater the demand rates of appropriate techniques were,and vice versa.Trainees with different grade of hospital had significant difference in cognition of learning difficulty of techniques,The higher trainees’ grade were,the lower the difficulty was(P＜0.01). Trainees with different grades of hospital had significant difference in satisfaction degree of teaching(P＜0.05),the satisfaction degree of counties higher than towns’(P＜0.01).Trainees with different titles(τ=-0.085,P＜0.05),education(τ=-0.016,P＜0.01), hospital’s grades(τ=-0.020,P＜0.01)and major(Hc=12.512,P＜0.01)had significant difference in demand of retraining,The lower trainees’ titles,education and grade were,the greater the demand rates were.Trainees with different major had significant difference in grasp rates(Hc=22.063,P＜0.01).②teachers’ factors.Title:there wasn’t significant difference in the satisfaction degree among trainees(τ=0.072,P＞0.05). 92.02%or 2.97%trainees satisfied or dissatisfied with teaching.Source:Trainees had higher satisfaction with experts who have hold techniques(87.84%)than local experts (12.16%).(3)cost-effectiveness analysis.Cost accounting:total,direct and indirect cost were 225703.28,169454.48,56248.80 yuans,respectively,total,direct and indirect cost single techniques were 367.47—450.44,260.68—343.75,68.30—115.22 yuans.②measurement of effects:cognitive effects of single techniques were 9.43%—52.00%;average scores of single techniques were 11.43—74.54,satisfactionof single techniques were 80.76%—100%.③cost-effectiveness ratio:cost-effectiveness ratio of cognition of the single techniques were 7.22—38.97,cost-effectiveness ratio of scores of the single techniques were 5.23—32.15,cost-effectiveness ratio of satisfaction of the single techniques were 80.76—100.Cost-effectiveness ratio and incremental cost-effectiveness ratio of scores of the chinese medicine techniques are 35.20 and 54.67,respectively,(4)promotion effects evaluation:The usage rate and the effective rate of single techniques had significant difference.The usage rate and the effective rate of chinese medicine techniques were 11.11%—44.90 and 87.64%—95.97% respectively.Conclusions(1)The training and promotion of Chinese medicine appropriate technology in Gansu had achieved better effect.(2)training effects were influenced by trainees’ factors(title,education,level of hospitals and major,)and teacher’ title and source.(3)training method was a important influencing factors of cost-effectiveness analysis.We should choose economical and effective training method according to technical characteristic,funds,and so on.(4)No supported product and lack of patients were the major reason of techniques not been used.Shortage of funding and no hardware and software conditions were main hindering factors of promotion of Chinese medicine techniques.(5)background determined model,model dominated mechanism,and mechanism promote extention..Promotion of Chinese medicine techniques in our province were suitable for government-supported model更多还原