上海市中心城区社区医疗机构肿瘤安宁疗护资源使用状况调查及医护人员职业满意度分析  

Hospice Care Resource Utilization Related to Cancer Management and Hospice Care Physicians and Nurses’Occupational Satisfaction:a Survey from Community Healthcare Institutions in Shanghai’s Central Districts

作　　者：杨森 赵华新[4] 牛晓敏 陈晨 张文静 葛许华 陆媛 马乐[1,2,3] 史晓晓 于德华 YANG Sen;ZHAO Huaxin;NIU Xiaomin;CHEN Chen;ZHANG Wenjing;GE Xuhua;LU Yuan;MA Le;SHI Xiaoxiao;YU Dehua(Department of General Practice,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China;Academic Department of General Practice,Tongji University School of Medicine,Shanghai 200090,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Tongji University,Shanghai 200082,China;Shanghai Lung Tumor Clinical Medical Center/Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;Jiangning Road Sub-district Community Health Center,Jing'an District,Shanghai 200052,China;Yangpu District Daqiao Community Health Center,Shanghai 200090,China)

机构地区：[1]同济大学附属杨浦医院全科医学科,上海市200090 [2]同济大学医学院全科医学系,上海市200090 [3]上海市全科医学与社区卫生发展研究中心,200090 [4]同济大学,上海市200082 [5]上海交通大学附属胸科医院上海市肺部肿瘤临床医学中心,上海市200030 [6]上海市静安区江宁路街道社区卫生服务中心,200052 [7]上海市杨浦区大桥社区卫生服务中心,200090

出　　处：《中国全科医学》2021年第12期1541-1545,共5页Chinese General Practice

基　　金：2018年同济大学附属杨浦医院院级课题项目(Se1201840);上海市领军人才(YDH-20170627);2019年上海市卫生健康委先进适宜技术推广项目(2019SY048);2017年上海市青年医师培养资助计划第五批。

摘　　要：背景上海安宁疗护服务已走过30余年的历程,目前上海全市246家社区卫生服务中心已全部开展安宁疗护服务,经过多年的发展,上海积极推进试点、制订服务规范、实施能力培训等措施,有力推动了安宁疗护持续、规范、高效发展。目的了解上海市中心城区社区医疗机构肿瘤安宁疗护资源使用状况及从业医护人员的满意度情况。方法2019年3—9月采用单纯随机抽样法分别从上海市7个中心城区(黄浦区、徐汇区、杨浦区、普陀区、静安区、长宁区、虹口区)的14家试点安宁疗护社区卫生服务中心选取安宁疗护从业医护人员42名为研究对象。分析试点机构2018年卫生统计报表和财务报表(安宁疗护病床使用率、安宁疗护时间、安宁疗护中心人均医疗费用、安宁疗护中心日均医疗费用)。并采用自行设计的《上海市安宁疗护试点机构医护人员从业满意度调查问卷》对医护人员从业满意度进行调查与访谈,具体内容包括受访者的基本信息、从业满意度(薪资福利、职业发展、职业认同感、离职意向、同行关系、工作满意度)以及影响安宁疗护从业医护人员职业满意度的因素。结果2018年上海市中心城区试点安宁疗护机构的安宁疗护病床使用率为(48.42±2.34)%;平均住院时间为(41.8±3.5)d,人均医疗费用为(7632.8±234.7)元,日均医疗费用为(182.6±22.6)元;居家安宁疗护平均时间为(56.2±7.5)d,人均医疗费用为(1371.3±186.4)元,日均医疗费用为(24.4±4.2)元。社区医疗机构安宁疗护从业医护人员对薪资福利、职业发展的满意度偏低,对同行关系和职业认同感的满意度偏高。安宁疗护从业医护人员对居家安宁疗护和机构安宁疗护的工作满意度结果相似。影响安宁疗护从业医护人员开展机构安宁疗护服务的主要因素是:"待遇较低、工作量大,付出与收获不成比例""依靠机构自身运营补贴,专项经Background Hospice care has been implemented in Shanghai for over 30 years,and currently it can be accessed from all the community health centers(CHCs)(n=246)in the city.Actions taken in these years by Shanghai such as pilot projects promotion,development of standards for hospice care and hospice care-related trainings for medical workers,have promoted the sustainable,standardized and efficient development of hospice care.Objective To investigate hospice care resource use related to cancer management and hospice care physicians and nurses’occupational satisfaction based on a survey in community healthcare settings in Shanghai’s central districts Methods This survey was conducted from March to September 2019.From seven central districts(Huangpu District,Xuhui District,Yangpu District,Putuo District,Jing’an District,Changning District and Hongkou District)selected by simple random sampling,14 CHCs delivering hospice care as the pilot institutions were extracted by stratified sampling,from which 42 hospice care physicians and nurses were sampled by use of simple random sampling.Data about hospice care resource use,such as occupancy rate of hospice beds,average length of hospice care per capita,average medical expense per capita and average daily medical expense per capita in the hospice care center were collected from the 2018 health statistics and financial statements of these CHCs.A self-developed questionnaire named Hospice Care Physicians and Nurses’Occupational Satisfaction in Shanghai’s Pilot Institutions for Hospice Care,involving general demographics,occupational satisfaction(evaluated in terms of salary and welfare,career development,professional identity,turnover intention,peer relationships,job satisfaction)and associated factors,was used to survey the participants.Results In 2018,the occupancy rate of hospice beds,average length of hospice care per capita,average medical expense per capita and average daily medical expense per capita in the hospice care center were(48.42±2.34)%,(41.8±3.5)days

关 键 词：临终医护 安宁疗护 社区卫生服务中心 恶性肿瘤 采访(主题) 满意度 

分 类 号：R47[医药卫生—护理学]