【作者】 邱静梅；

【导师】 王健；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 医学技术水平的不断提高使人类抵抗疾病风险的能力不断增强,同时,提供当地需求、安全、有效、经济、医患双方可接受、符合社会伦理道德要求的卫生适宜技术日益被社会所关注。2008年,《卫生部关于加强适宜卫生技术推广工作的指导意见》中指出“坚持依靠卫生科学技术进步,研究农村卫生适宜技术需求,加强面向农村的卫生适宜技术推广工作,是全面贯彻我国卫生和科技工作方针,促进卫生科技成果转化,发展农村卫生服务的重要内容和关键环节,是提高基层医疗卫生技术水平和服务能力的重要措施。”2009年,卫生部新医改方案中明确强调“基层医疗卫生机构要使用适宜技术、适宜设备和基本药物,大力推广包括民族医药在内的中医药,为城乡居民提供安全有效和低成本服务。”因此,分析卫生适宜技术需求、评价卫生适宜技术临床效果对于了解农村居民卫生服务需求,筛选推广卫生适宜技术,发展基层卫生工作具有重要意义。目的：是评价卫生部第二轮“十年百项计划”第5-7批西医卫生适宜技术的临床效果；分析河南、宁夏2省农村地区的西医卫生适宜技术需求。方法：采用系统评价方法评价第5-7批西医卫生适宜技术的临床效果；采用访谈和问卷调查的方式分析西医卫生适宜技术需求,共调查河南省长葛、新密以及宁夏回族自治区青铜峡、中宁2省4县19个乡镇、230名县级医院医生、144名乡镇卫生院医生,248名村医。定性资料主要采用描述性分析,定量资料采用的统计分析方法包括t检验、χ2验、Meta分析。主要结果：(1)卫生部第5-7批西医卫生适宜技术系统评价结果显示,技术效果评价缺少足够的文献支持并且纳入文献的质量等级较低,其中23项技术纳入的文献数量低于5篇,28项技术的纳入文献中质量等级评定为“A”的文献数量为0,只有1项技术的结论强度评定为“强”。(2)两省常见病及诊治困难疾病均以常见慢性非传染性疾病为主。在河南省,主要包括脑血管疾病、糖尿病及其并发症、胃肠道疾病(溃疡、炎症)、新生儿疾病、高血压、哮喘、恶性肿瘤、风湿性疾病、妊娠合并症、慢性盆腔器官炎症10种疾病；在宁夏自治区,主要包括心脏病、脑血管疾病、糖尿病及其并发症、新生儿疾病、腰椎间盘突出、慢性盆腔器官炎症6种疾病。(3)河南省县乡村三级医疗机构主要需求心脏病、脑血管疾病、哮喘、新生儿窒息、慢性胃炎、糖尿病及其并发症6种疾病的治疗技术；宁夏自治区主要需求心脏病诊治技术以及慢性盆腔器官炎症的诊断技术。(4)推广时间短、缺少配套的医疗设备及药品是制约2省已推广卫生技术扩大需求的主要影响因素；特别在宁夏地区,“药品三统一”政策限制了部分推广技术所需的药品,是医生反映比较突出的问题。在推广技术清单中,缺少针对职业病(主要包括尘肺、矽肺、职业中毒等)、精神疾病的诊治技术。(5)影响西医卫生适宜技术需求的主要因素包括技术推广需要投入的资金、适宜技术引入对医院带来的经济效益、医务人员是否充足等。结论与建议：(1)增加文献数量、提高证据质量,不断完善适宜技术系统评价的结论(2)增加心脏病、脑血管疾病等慢性非传染性疾病诊治技术种类,适当筛选纳入常见职业病和社会病的诊治技术(3)加强医生对西医卫生适宜技术的认知,增加培训机会(4)为西医卫生适宜技术推广提供充足的资金保障更多还原

【Abstract】 The ability of resistance to diseases of human beings is improved due to the development of health technologies, meanwhile appropriate health technologies with the feature of local needs, safe, effective, economic, and acceptance to both parties, the respectance of health ethics are becoming important.In 2008, "Ministry of Health guidance on strengthening the promotion of Appropriate Health Technology " points "Relying on health technology, studying appropriate technology demands in rural, strengthening the promotion of appropriate health technology are important aspects and key segments for implementing the health principles, promoting health technology achievements, developping health services in rural and important measures to raise up the level and capability of primary health care. "In 2009, new medical reform plan published by the Ministry of Health clearly emphasizes "primary health institutions should use appropriate technology, appropriate equipment and essential drugs, expand to cover the national medicine including Chinese medicine greatly for the urban and rural residents with safe, effective and low cost services." Therefore, the research of appropriate health technology demands and systematic review for appropriate health technologies is important to meet the demands of rural residents and the development of primary health care.Aims:of this research:we evaluate clinical effection of the 5th-7th appropriate health technologies and analyze appropriate western health technology demands in provinces of Henan and Ningxia.Methods:Systematic evaluation is used to evaluate clinical effection of the 5th-7th appropriate health technologies; in order to research health technology demands, we surveyed 4 countries,19 towns,230 doctors from country hospicals,144 doctors from town hospicals,248village doctors through interview and stratified random sampling in Henan and Ningxia. Survey information is consisted of qualitative and quantitative data, including discriptive analysis, t test,χ2 test and Meta analysis.Key findings:(1) Through systematic evaluation on 5-7 western apprpriate health technologies, the relative articals were few and down grade.The artical number of 23 technologies was below 5 and no articles’quality was assessed "A". Only one techonology’s conclution was affirmed to"strong"and supported promotion.(2) Common or difficultly diagnostic (therapeutical) diseases are non-communicable chronic diseases. The disease mainly include cerebrovascular disease, diabetes and its complications, gastrointestinal disease (ulcer, inflammation), neonatal disease, hypertension, asthma, cancer, rheumatic diseases, pregnancy complications, chronic pelvic inflammatory 10 kinds of diseases in Henan; heart disease, cerebrovascular disease, diabetes and its complications, neonatal disease, lumbar disc herniation, chronic pelvic inflammation 6 kinds of diseases in Ningxia Autonomous Region.(3) There are therapeutic technology demands in connection with heart disease, cerebravascular disease, asthma, neonatal asphyxia, chronic gestritis, diabetes and its complications in Henan; diagostic and therapeutic technology demands in connection with heart disease, diagostic technology demand in connection with gynecopathy inflammation in Ningxia.(4) Short promoting time and lack of assorted medical equipment and medicine are the main influence factors restricting health technology demands in two provinces. Especially in Ningxia, "Unifying medicine in three aspects" policy restricts some essential medicine for generalized health technologies which is the main problem doctors reflected.There are lack of therapeutical technologies for occupational diseases and sociopath in technology lists.(5) The main factors influencing western appropriate health technology demands include found, economic benefit, the number of doctors and so on. Conclusions and recommendations:(1) To increase number and improve quality of relative articals for perfect conclusion by systematic review.(2)To increase therapeutical technologies used to chronic diseases such as heart disease, cerebrovascular disease and diagnostic and therapeutic technologies for occupational diseases and sociopath.(3)To strength the acceptance and increase training opportunities of health appropriate technologies in doctors in rural.(4)To provide enough fund for popularizing appropriate western health technologies.更多还原