基于模糊集的村医抗生素不合理使用影响因素的定性比较分析  

Fuzzy-set qualitative comparative analysis of influence factors on village doctors'antibiotic misuse

作　　者：郭沙沙 沈立岩[1,2] 王权 姚璐 甄雪梅[1,2] 孙强 GUO Sha-sha;SHEN Li-yan;WANG Quan;YAO Lu;ZHEN Xue-mei;SUN Qiang(Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan Shandong 250012, China;NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan Shandong 250012, China;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto M5T 3M6, Canada)

机构地区：[1]山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心,山东济南250012 [2]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),山东济南250012 [3]多伦多大学卫生政策管理与评价研究所,加拿大多伦多M5T3M6

出　　处：《中国卫生政策研究》2021年第7期62-67,共6页Chinese Journal of Health Policy

基　　金：国家自然科学基金面上项目(71774103)。

摘　　要：目的:从工作年限等医生自身和医疗收入等外部环境因素出发,对村医不合理使用抗生素的影响因素进行研究,以探索不同因素组合对村医抗生素不合理使用的作用路径,促进村医抗生素合理使用。方法:利用非参与观察的方法,对山东省聊城市S县和Y县的10家村卫生室的12名村医的真实诊疗行为进行为期一周的现场观察和记录。利用fsQCA3.0软件对村医抗生素不合理使用的影响因素进行基于模糊集的定性比较分析。结果:医生自身和外部环境交互作用影响村医抗生素不合理使用。共有4条路径可能造成村医抗生素不合理使用。其中,医疗收入低,诊断率低,处方书写情况差的组合是导致村医抗生素不合理使用的主要原因。结论:村医抗生素不合理使用行为受到医生自身和外部环境不同因素间相互作用,相互关联的影响。应该从医生自身和外部环境等方面共同干预,以改善村医抗生素不合理使用问题。Objective:Based on our research into influence factors relating to village doctors'antibiotic misuse from the perspectives of doctors'personal factors(including working years)and external factors(including low medical income),this paper explores the influence mechanism of different factor combinations on such misuse,with a view to promoting village doctors'rational use of antibiotics.Methods:The non-participant observation was adopted in a one-week observation and record of actual diagnosis and treatment behaviors of 12 village doctors with 10 village clinics in S and Y counties,Shandong province.Meantime,fsQCA3.0 software was applied for a fuzzy-set qualitative comparative analysis of influence factors on village doctors'misuse of antibiotics.Results:The antibiotic misuse is due to the interacted and combined effect of doctors'personal factors and other external factors.There are four paths that may lead to village doctors'antibiotic misuse.In particular,the combination of low medical income,low diagnostic rate and illegible handwriting of prescriptions is the main reason for such misuse.Conclusions:As the antibiotic misuse by village doctors is caused by the interacted and interrelated influence of doctors'personal factors and other external factors,joint intervening measures corresponding to such factors are advised to reduce village doctors'antibiotic misuse.

关 键 词：村医 抗生素 非参与观察 定性比较分析 

分 类 号：R197[医药卫生—卫生事业管理]