医防融合视角下浙江省县域医共体慢性病一体化门诊服务开展现状评价及改进对策研究  

Evaluation and Improvement Countermeasures Research of the Current Situation of Integrated Outpatient Service for Chronic Diseases in County Medical Community in Zhejiang Province from the Perspective of Medical Prevention Integration

作　　者：林晓玲[1] 瞿楷校 李旭[1] 陈静纯 黄群芳 周驰[1] LIN Xiaoling;QU Kaixiao;LI Xu;CHEN Jingchun;HUANG Qunfang;ZHOU Chi(School of Public Health,Hangzhou Normal University,Hangzhou 311121,China;Hangzhou Linping District Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou 311199,China)

机构地区：[1]杭州师范大学公共卫生学院,浙江省杭州市311121 [2]浙江省杭州市临平区中西医结合医院,311199

出　　处：《中国全科医学》2025年第13期1649-1654,1667,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(72274050);教育部人文社会科学研究一般项目(22YJCZH262)。

摘　　要：背景为推动分级诊疗制度和健康中国建设,国务院办公厅明确指出要在县域组建医疗共同体,浙江省在医共体建设中率先进行了慢性病一体化门诊的探索,而目前国内关于慢性病一体化门诊的研究主要集中在概念探讨,针对服务现状开展的定量研究较少。目的了解浙江省县域医共体慢性病一体化门诊服务开展现状并探究其影响因素,为完善慢性病一体化门诊运行提供对策建议。方法于2023年10—11月,采用典型抽样法兼顾地理位置均衡原则,选取浙江省杭州临平区、台州玉环市、衢州江山市、嘉兴嘉善县4个地区的6家医共体下的18家社区卫生服务中心/乡镇卫生院,在相应机构门诊候诊处拦截门诊患者。采用课题组自设问卷调查患者对慢性病一体化门诊服务的评价,评价内容涉及服务类别、服务途径及团队建设3方面。结果共发放问卷540份,回收有效问卷510份,问卷有效回收率为94.4%。患者对慢性病一体化门诊服务的总体评分为(4.4±0.5)分,对诊前服务的评分为(4.4±0.5)分,对诊中服务的评分为(4.3±0.5)分,对诊后服务的评分为(4.1±0.6)分,对服务途径维度各条目的平均评分均≥3.7分,对服务团队建设维度各条目的平均评分均≥3.9分。多元线性回归分析结果显示,年龄、学历、月收入、对医院诊疗环境的满意度、对医院总体医疗服务能否满足自身需求的满意度是患者对慢性病一体化门诊服务评分的影响因素(P<0.05)。结论浙江省县域医共体慢性病一体化门诊服务开展现状整体较好,但在诊后服务、服务途径、总体医疗服务水平上仍有待改进。浙江省基层医疗卫生机构应重视诊后服务的延续性,强化慢性病一体化门诊服务方式与团队建设,促使医疗服务向多元化、高质量方向发展,提升居民就医体验感。Background In order to promote the hierarchical diagnosis and treatment system and the construction of healthy China,the General Office of the State Council clearly pointed out that a medical community should be established in the county.Zhejiang Province took the lead in exploring the integrated outpatient service of chronic diseases in the construction of medical community.At present,the research on the integrated outpatient service of chronic diseases in China mainly focuses on the discussion of concepts,and less quantitative research is carried out on the current situation of services.Objective To analyze the current situation of the integrated outpatient service of chronic diseases in county medical communities in Zhejiang Province and explore its influencing factors,so as to provide countermeasures and suggestions for improving the operation of the integrated outpatient service of chronic diseases.Methods From October to November 2023,using the typical sampling method and taking into account the principle of geographical balance,18 community health service centers/township hospitals under 6 medical communities in Linping District of Hangzhou,Yuhuan City of Taizhou,Jiangshan City of Quzhou and Jiashan County of Jiaxing in Zhejiang Province were selected,and outpatients were intercepted at the outpatient waiting offices of corresponding institutions as the research objects.A self-designed questionnaire was used to investigate the patients'evaluation of integrated outpatient services for chronic diseases.The evaluation content involved three aspects:service category,service approach and team building.Results A total of 540 questionnaires were distributed and 510 valid questionnaires were recovered,with an effective recovery rate of 94.4%.The overall score of patients'integrated outpatient service for chronic diseases was(4.4±0.5)points,and the scores of each service category were:pre-diagnosis service(4.4±0.5)points,in-diagnosis service(4.3±0.5)points,and post-diagnosis service(4.1±0.6)points.The average s

关 键 词：医防融合 县域医共体 慢性病一体化 服务评价 服务改进 

分 类 号：R197[医药卫生—卫生事业管理]