四川省严重精神障碍“医院-社区一体化服务模式”推行的阻碍因素研究——基于扎根理论的探索  

A study on the obstacles in the implementation of “hospital-community integrated service model” for severe mental disorders in Sichuan Province: exploration based on the Grounded Theory

作　　者：梁雨 冯琬婷 李慧[2] 苏荣成 张艺凡 成龙 郭瑞清 王梦媛 苗蕴琪 李佳圆 LIANG Yu;FENG Wan-ting;LI Hui;SU Rong-cheng;ZHANG Yi-fan;CHENG Long;GUO Rui-qing;WANG Meng-yuan;MIAO Yun-qi;LI Jia-yuan(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041 [2]四川省医学科学院·四川省人民医院四川省精神医学中心,四川成都610072

出　　处：《现代预防医学》2022年第24期4462-4466,4523,共6页Modern Preventive Medicine

摘　　要：目的 深入挖掘四川省严重精神障碍“医院-社区一体化服务模式”推行的阻碍因素。方法 结合分层抽样、立意抽样和理论抽样,选择四川省“医院-社区一体化”服务模式推行中各工作环节的服务提供者共19名进行半结构化访谈,采用程序化扎根理论的方法,运用Nvivo 12.0 pro软件对访谈所获资料进行整理分析,并用雷达图探索不同工作模式地区共性和特性的阻碍因素。结果 通过三级编码和理论饱和度检验,得到了服务提供者的负向意愿、人员障碍、制度障碍、管理障碍、服务接受者负向意愿、客观条件障碍、社会环境障碍、政策障碍8个主范畴的阻碍因素及其对一体化服务推行的影响,构建了重精一体化服务推行阻碍因素模型;不同工作模式地区间的阻碍因素分布有较大差异。结论“人员障碍”等8个主范畴的阻碍因素直接或间接影响一体化服务提供和利用的各个环节,不同地区应根据当地实际工作面临的主要阻碍因素针对性地采取措施以推进一体化服务模式的实施。Objective To explore the obstacles to the implementation of “hospital-community integrated service model” of patients with severe mental disorder in Sichuan Province. Methods In combination with stratified sampling, purview sampling and theory sampling, a total of 19 service providers in all aspects of the implementation of hospital-community integrated service model in Sichuan Province were selected for semi-structured interviews. The data obtained from the interviews were sorted out and analyzed by using the method of programmed grounded theory and Nvivo 12.0 Pro software. Radar chart was used to explore the common and specific hinder factors in areas with different working modes. Results Through the three-level coding and theoretical saturation test, eight catagories of hindrance factors( the negative intention of service providers,personnel barrier, institutional barriers, management barriers, the negative intention of the service recipient, obstacles of ob-jective conditions, social and environmental barriers, policy barriers) and their influence on the implementation of integrated services were obtained, furthermore, the model of hinder factors of the implementation of integrated services were conducted.The distribution of hindering factors varied greatly among areas with different working modes. Conclusion Eight catagories of hindrance factors such as personnel barrier directly or indirectly affect the provision and utilization of integrated services. Dif-ferent regions should take targeted measures to promote the implementation of “integrated service model” according to the main obstacles faced by local actual work.

关 键 词：严重精神障碍 医院-社区一体化服务 阻碍因素 扎根理论 

分 类 号：R749[医药卫生—神经病学与精神病学] R197.32[医药卫生—临床医学]