上海市基层中医药服务能力状况分析  

Analysis of the Status of Grassroots Traditional Chinese Medicine Service Capacity in Shanghai

作　　者：张诗文 荆丽梅 杨洋 王静蓉 李雪莹 王丽丽 ZHANG Shiwen(School of Public Health,Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China)

机构地区：[1]上海中医药大学公共健康学院,上海201203 [2]上海交通大学医学院,上海200025 [3]上海市卫生健康委员会中医服务监管处,上海200125

出　　处：《医学与社会》2025年第4期117-122,共6页Medicine and Society

基　　金：首都医科大学国家医疗保障研究院开放性课题,编号为YB2023B08;上海市卫生健康委员会委托课题“上海市基层中医药服务能力提升工程“十四五”行动计划实施方案”;上海市卫生经济学会科研项目,编号为HXZZ09。

摘　　要：目的:通过质性研究分析上海市基层中医药服务能力状况及瓶颈问题,为提升基层中医药服务能力提供循证依据。方法:于2022年7-8月,面对面访谈上海市16个区中医药管理部门的负责人,采取目的性抽样选取32家社区卫生服务中心进行关键知情者访谈。对访谈资料采用词频分析与扎根理论相结合的方法,经过三级编码与交叉分析,分析并归纳基层中医药服务能力发展存在的问题。结果:共纳入48份访谈资料。总体情况词频分析显示排在1-5位的高频词分别是“信息化”“高血压”“慢性病”“研修班”“积极性”,分维度词频分析得出关键知情者较为关注的5个环节,分别为信息化建设、慢性病管理、人才培养、绩效考核及激励机制与医联体内资源流通。通过三级编码提炼出97个三级节点、30个二级节点和6个一级节点,得到影响服务能力发展的6个范畴包括人才培养、政策制度、资金扶持、信息建设、宣传机制、医联体协同。交叉分析结果发现政策制度在所有区域都得到较高重视,人才培养的城郊差异较为显著。结论:上海市基层中医药服务能力不断提升,但仍存在信息化水平普遍较低、群众对中医药和慢性病管理的认识不足、基层中医药人才长效培养机制不健全、配套政策不完善且专项资金投入不足等问题。Objective:To assess the current status and challenges in the development of grassroots traditional Chinese medicine(TCM)services in Shanghai,so as to provide evidence-based insights for enhancing their capacities.Methods:From July 2022 to August 2022,face-to-face interviews were conducted with the heads of TCM management departments in 16 districts of Shanghai,and key personnel from 32 community health service centers in Shanghai were interviewed.Based on a combined approach of word frequency analysis and grounded theory,interview data were subjected to three-level coding and cross-analysis to identify and summarize the key issues hindering the development of grassroots TCM services.Results:Analysis of 48 interviews revealed that"informationization,""hypertension,""chronic diseases,""training courses,"and"enthusiasm"were the top 5 high-frequency words.Key informants focused on informationization construction,chronic disease management,talent cultivation,performance assessment,incentive mechanisms,and resource circulation within medical consortia.Through three-level coding,97 third-level nodes,30 second-level nodes,and 6 first-level nodes were extracted,revealing six key domains influencing service capacity development,including talent cultivation,policy systems,financial support,information infrastructure,publicity mechanisms,and medical alliance collaboration.Cross-analysis showed significant attention to policy systems across all regions,with urban-rural disparities in talent cultivation.Conclusion:While grassroots TCM services in Shanghai are improving,challenges persist,including low levels of informationization,public understanding of TCM and chronic disease management,insufficient talent cultivation mechanisms,incomplete policies,and inadequate fund allocation.

关 键 词：中医药管理 服务能力 基层 上海 

分 类 号：R-05[医药卫生] R197