主动健康视角下上海市社区卫生服务机构肿瘤管理状况调查  

Status of cancer management in community health service institutions in Shanghai from the perspective of proactive health

作　　者：张倩倩 金花 黎婉钰 于德华 Zhang Qianqian;Jin Hua;Li Wanyu;Yu Dehua(Department of General Practice,Yangpu Hospital,School of Medicine,Tongji University,Shanghai 200090,China;Shanghai General Practice and Community Health,Development Research Center,Shanghai 200090,China;Research Center for General Practice,School of Medicine,Tongji University,Shanghai 200090,China;Community Health Service Center of Xiayang Street,Qingpu District,Shanghai 201799,China)

机构地区：[1]同济大学附属杨浦医院全科医学科,上海200090 [2]上海市全科医学与社区卫生发展研究中心,上海200090 [3]同济大学医学院全科医学研究中心,上海200090 [4]上海市青浦区夏阳街道社区卫生服务中心,上海201799

出　　处：《中华全科医师杂志》2025年第4期458-464,共7页Chinese Journal of General Practitioners

基　　金：国家自然科学基金(72104183);上海市领军人才(YDH-20170627);上海市医院协会医院管理研究基金课题(X2020168);2021年上海市“医苑新星”青年医学人才培养资助计划;第十批上海市杨浦区中心医院青年人才“晨光计划”(Ye1202105)。

摘　　要：目的了解上海市社区卫生服务机构肿瘤管理过程中主动健康管理实施现状。方法该研究为横断面调查。2022年7月,根据目前上海市社区卫生服务机构基于主动健康理念实施的肿瘤管理内容设计调查问卷,对上海市16个行政区范围内的全部247家社区卫生服务机构进行调查,了解其肿瘤筛查情况、肿瘤患者健康档案建立情况和肿瘤患者随访情况。结果发放问卷247份,回收239份,有效问卷228份,有效回收率92.3%(228/247)。228家社区卫生服务机构中,城区72家(31.6%),近郊区101家(44.3%),远郊区55家(24.1%)。89.0%(203/228)的机构开展了肿瘤筛查,筛查病种包括大肠癌、肺癌、肝癌、乳腺癌和胃癌。92.5%(211/228)的机构为肿瘤患者建立了健康档案。99.1%(226/228)的机构开展了肿瘤患者随访,其中,29.6%(67/226)的机构对肿瘤患者每年进行1~2次随访,42.5%(96/226)的机构随访频率视患者卡氏评分情况确定,99.1%(224/226)的机构进行电话随访。84.6%(193/228)的机构对肿瘤患者及其家属进行针对性健康教育,其中,78.8%(152/193)的机构开展运动指导、76.2%(147/193)的机构开展心理相关知识指导。城区、近郊区和远郊区社区卫生服务机构开展肿瘤筛查、建立健康档案、对肿瘤患者进行随访的频率、对肿瘤患者的随访评估内容、对肿瘤患者的随访方式、开展肿瘤健康教育服务和对肿瘤患者及家属健康教育的内容比较,差异均无统计学意义(均P>0.05)。结论上海市社区卫生服务机构对肿瘤筛查的病种尚未完全覆盖,随访质量有待提高,健康教育尚不全面,城区、近郊区和远郊区肿瘤筛查、建档、随访情况及健康教育情况无差异。Objective To investigate the current status of the implementation of active health management in tumor care in community health service institutions in Shanghai.Methods This cross-sectional study was conducted in July 2022.A questionnaire was designed based on tumor management practices according to active health principles was designed and distributed to all 247 community health service institutions in 16 administrative districts of Shanghai.Data were collected on tumor screening,establishment of health records for tumor patients,and follow-up practices.Results Of the 247 questionnaires distributed,239 were returned,with 228 valid responses(effective response rate:92.3%).Of the 228 institutions,72(31.6%)were located in urban areas,101(44.3%)in suburban areas,and 55(24.1%)in rural areas.Tumor screening was performed by 89.0%(203/228)of the institutions,mainly for colorectal,lung,liver,breast,and gastric cancers.Health records for tumor patients were established by 92.5%(211/228)of institutions.Follow-up of tumor patients was conducted by 99.1%(226/228)of institutions,with 29.6%(67/226)performing 1-2 annual follow-ups.Telephone follow-up was used by 99.1%(224/226)of institutions,while 42.5%(96/226)adjusted the frequency of follow-up based on patients′Karnofsky Performance Status scores.Targeted health education for patients and families was provided by 84.6%(193/228)of institutions,including exercise guidance(78.8%,152/193)and psychological support(76.2%,147/193).No statistically significant differences were observed among urban,suburban,and rural institutions in tumor screening,health record establishment,follow-up frequency,assessment content,follow-up methods,and tumor health education and content(all P>0.05).Conclusions The coverage of tumor screening in Shanghai′s community health service institutions remains incomplete,the quality of follow-up needs to be improved,and health education programs are not comprehensive.There were no regional differences in tumor screening,health record establishment,follow-u

关 键 词：社区卫生中心 肿瘤 主动健康管理 

分 类 号：R197.1[医药卫生—卫生事业管理]