【作者】 孙瑶；

【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， 2008， 硕士

【摘要】 研究背景:康复医学被WHO列为继临床医学和预防医学之后的第三医学,它是在患者经过抢救治疗、保持生命体征的同时,就开始介入的以恢复重建机体生理和心理功能、提高生命和生活质量为目标的医学科学。现代康复医学自20世纪80年代由欧美等发达国家引入我国,随着经济发展、社会进步和人民群众生活水平的提高,公众对生活质量的要求和对康复医疗的需求日趋增高,国家为发展残疾人事业也将康复医疗纳入发展计划,并提出了到2015年实现残疾人“人人享有康复服务”的目标。济南市残疾事业“十一五”发展规划提出,要提前5年实现残疾人“人人享有康复服务”的目标,创建全国康复示范城市。目的:我们试图通过流行病学调查,了解济南市三级医院康复科的基本情况,康复医生对康复医疗服务的利用情况及患者对康复医疗服务的利用情况,探讨影响康复服务利用的因素,以期为康复服务供方提供有针对性的康复服务提供参考。方法:(1)通过对大量文献的回顾性分析,结合对有关专家的咨询、访谈确定康复医疗服务利用及其影响因素的调查内容,并编制调查问卷。(2)培训调查人员,进行预调查。(3)采用目的抽样法,对19家医院的106名康复医生进行问卷调查,并对济南市4家三级医院康复医学科的192名患者进行现场调查。用SPSS11.5统计软件对所得数据进行卫生统计学分析。(4)用循证医学分析脑卒中康复医疗服务的效果。结果:(1)中风、关节炎、脊髓损伤是患者来三级医院寻求康复医疗服务的前3位的原因。(2)调查结果显示,康复医疗技术中水疗、听觉康复等利用较少,理疗、针灸等传统治疗手段应用较多。芬必得等治疗慢性疼痛的药物在康复医学科应用最广泛。(3)多数康复科医生及患者认为,所利用的或接受的康复医疗服务项目有效;循证医学研究结果认为,早期针灸治疗联合早期康复治疗脑卒中的效果优于单纯早期康复的治疗效果。(4)济南市三级医院康复医学科患者的保险覆盖率较高,44.9%的患者享受公费医疗,39.8%的患者享受职工医疗保险。(5)影响济南市三级医院康复医疗服务利用的因素有年龄、性别、文化程度、是否是家庭主要收入来源、家庭平均月收入、医疗费用支付方式等。结论:济南市三级医院康复医疗服务利用率较高,且还有很大的发展潜力。根据康复疾病的特点,应加强对中风、关节炎等慢性疾病的预防及治疗,大力发展社区康复,建立安全、通畅、高效的双向转诊机制,才能适应广大居民日益增长的康复需求;还存在诸多影响三级医院康复医疗服务利用的因素,必须采取有针对性的措施以使越来越多的居民享受到康复医疗服务。更多还原

【Abstract】 Background: Modern rehabilitation has been regarded as the third medical science following clinical medical science and public health science. Nowadays, more and more people have realized the importance of rehabilitation for the disabled or quality of life. Based on the increasing need on rehabilitation training, we must take action to improve the rehabilitation service.Objective: To get to know the basic condition of rehabilitation services and to explore the related factors for supply and utilization of rehabilitation in four grade A hospitals in Jinan, and to put forward policy suggestions to satisfy the need for rehabilitation services of disabled persons in Jinan.Methods: Through literature research, related materials and consultation from some experts, questionnaires were made, and also investigators were trained and carried out the investigations in four grade A hospitals in Jinan. Spss11.5 software was used to analyze the data and evidence-based medicine was used to analyze the effect of acupuncture and early rehabilitation on stroke.Results: (1) Stroke, arthritis and spinal cord injuries were the most important three diseases had rehabilitation utilization in the four grade A hospitals in Jinan. (2) Water therapy and auditory rehabilitation were seldom used, while physical therapy and traditional Chinese rehabilitation techniques were often used. Fenbide is the most widely used drug for rehabilitation in this present study. (3) Most patients or doctors believed that rehabilitation was effective. Evidence-based medicine results showed that acupuncture in combination with early rehabilitation was superior to early rehabilitation only in treating stroke. (4) Patients using rehabilitation in the four grade A hospitals in Jinan had high insurance exposure ratios. (5) Age, gender, education level, whether or not being the main income source of the family, mean income of the family and means of payment for the medical fees are influencing factors for rehabilitation utilization in grade A hospitals in Jinan.Conclusion: Rehabilitation has great developmental potentialities in grade A hospitals in Jinan. Based on the present study, stroke and arthritis should be paid more attention on prevention and treatment, and also community rehabilitation should be widely developed so as to meet the increasing need of rehabilitation.更多还原