我国东部和西部地区主要慢性病卫生服务提供利用现状分析  

Present Situation of Delivery and Utilization of Health Services for Major Chronic Diseases in the Eastern and Western China

作　　者：赵秀竹[1] 那琳娜[1] 朱兆芳[1] 

机构地区：[1]卫生部卫生发展研究中心,北京市100191

出　　处：《中国全科医学》2014年第14期1646-1649,共4页Chinese General Practice

基　　金：世界银行委托课题:医改框架下慢性病防控策略研究(A23-10)

摘　　要：目的了解我国东部和西部地区主要慢性病卫生服务提供利用情况及其影响因素,为医改框架下慢性病防治策略的制定提供证据支持和政策建议。方法于2012年3—4月,选取浙江省嘉兴市秀洲区、浙江省桐乡市、云南省楚雄州楚雄市、云南省禄丰县为调查现场,选取区域内的全部区/县级疾病预防控制中心、区/县级综合医院及部分乡镇卫生院/社区卫生服务中心、村卫生室/社区卫生服务站,采用专人在以上医疗机构调查1天的形式,选择当天在机构就诊的全部480名慢性病患者为调查对象。利用各地区医院信息系统汇总相关数据,收集卫生机构财务年报资料、卫生统计年报资料等,对各地区慢性病服务提供和利用情况进行调查。采用问卷调查方法,对480名患者的就诊机构选择情况及原因进行调查。结果 480名慢性病患者中,有47.9%（230/480）的患者首诊选择到乡镇卫生院就诊,有32.1%（154/480）的患者首诊选择到县级医院就诊,选择村卫生室首诊者仅占16.0%（77/480）。东部地区每乡镇平均管理4 000~5 000名高血压患者、900多名糖尿病患者;西部地区每乡镇平均管理1 000多名高血压患者、300多名糖尿病患者。除秀洲区因无区/县级医疗机构外,桐乡市和楚雄市的高血压患者门诊主要流向乡级医疗机构,住院主要流向区/县级医疗机构;禄丰县门诊和住院均以流向区/县级医疗机构为主。桐乡市糖尿病患者门诊和住院均以区/县级医疗机构为主;楚雄市门诊和住院均以乡级医疗机构为主;禄丰县门诊以乡级医疗机构为主,住院以区/县级医疗机构为主。结论目前基层卫生机构的主要慢性病防控能力较弱,慢性病患者的分流不合理。建议增加公共卫生人员数量,提高服务能力;提高激励水平,配备必要的交通工具;加强宣传发动,全民多部门参与。Objective To understand the current delivery and utilization of health services for major chronic diseases in the Eastern and Western China,and to study the factors affecting service providers and resident utilization,in order to provide evidence support and policy advices for making chronic disease prevention and treatment strategies under the framework of the medical reform.Methods From March 2012 to April 2012,Xiuzhou Area of Jiaxing City in Zhejiang Province,Tongxiang City in Zhejiang Province,Chuxiong City of Chuxiong Prefecture in Yunnan Province,and Lufeng County in Yunnan Province were chosen as investigation sites.The researchers were assigned to carry out one-day investigation on all the district / county level disease prevention and control centers,all the district / county level general hospitals,some town health clinics and some village clinics of the chosen areas.480 chronic disease patients in treatment that day were chosen as questionnaire subjects on their service selection reasons.The researchers also collected data from the hospital information systems,annual financial reports and annual health statistic reports from health agencies.Results Among 480 chronic disease patients,47.9%（230 /480） chose town clinics during first treatment,32.1%（154 /480） chose county level hospitals during first treatment,and only 16.0%（77 / 480） chose village clinics during first treatment.There are 4 000-5 000 hypertension patients and over 900 diabetes patients in each town of East China in average.There are over 1 000 hypertension patients and over 300 diabetes patients in each town of West China in average.There is no district / county level medical institution in Xiuzhou Area.The hypertension patients of Tongxiang City and Chuxiong City mainly accept outpatient service at town clinics,and are hospitalized at county level clinics.The hypertension patients of Lufeng County mainly choose county level clinics for outpatient service and hospitalization.The diabetes patients of Tongxiang City mainly choose

关 键 词：慢性病 卫生服务研究 卫生保健提供 

分 类 号：R197[医药卫生—卫生事业管理]