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目的探讨欠发达地区开展社区卫生服务的方法,研究提高医疗公平和效率,方便群众就医,减轻费用负担的具体模式。方法(1)在濮阳市,采用分层、系统抽样方法抽取了8231位居民,进行了社区卫生服务需求调查。(2)普查了市城区社区卫生服务试点和市城区的卫生资源情况。(3)提出网络建设的方法和社区健康教育工作重点,并进行了实施。(4)运用层次分析法,建立了社区卫生服务层次分析评价体系(CHS-AHP)社区卫生服务综合评估模型GI=∑1GiPi,对卫生服务站进行纵向和横向评估。结果(1)濮阳居民对社区卫生服务需求水平较高:慢性病患病率为75.45‰;患者中就诊构成比为84.39%,未就诊构成比为15.61%。(2)两周患病者实际就诊基层医疗卫生单位的占71.30%。(3)在发展社区卫生服务过程中,建立合适的社区卫生服务网络模式,是发展社区卫生服务的关键措施。网络实施后居民对社区卫生服务的需求情况、满意度有很大提高;高血压患者正规服药、血压控制情况有很大改善;社区居民的卫生知识掌握率、不良行为暴露率有明显变化。(4)社区健康教育在社区卫生服务工作中占据着重要地位。社区卫生服务综合指数从1999—2006年依次是0.4348,0.4702,0.6206,0.7561,0.7971,0.8613,0.8853,0.9005,呈逐年增长趋势;社区健康教育综合指数从1999—2006年依次是0.3735,0.4966,0.6140,0.7158,0.7574,0.8091,0.8270,0.8418,呈逐年增长趋势。社区卫生服务和社区健康教育相关性有统计学意义(r=0.988,P<0.005)。结论在濮阳市构建了有利于帮助社区居民形成健康的生活方式和促进慢性病管理的网络模式,该模式具有较强的实用性和可操作性。提出并证明了“以社区健康教育为载体,把社区卫生服务引向深入”是开展社区卫生服务的有效途径。建立了完善的社区卫生服务评价体系。
Objective To explore ways to develop community health services in underdeveloped areas and to study specific modes of improving medical fairness and efficiency, facilitating medical treatment for the masses and reducing the burden on expenses. Methods (1) In Puyang City, 8231 residents were sampled by stratified and systematic sampling method, and the demand of community health service was investigated. (2) Census of urban community health service pilot and city health resources. (3) Proposed network construction methods and community health education priorities, and carried out. (4) Using AHP, the CHS-AHP community health service comprehensive assessment model GI = Σ1GiPi was established to evaluate the health service stations vertically and horizontally. Results (1) Puyang residents had higher demand for community health services: the prevalence of chronic diseases was 75.45 ‰; the proportion of patients in consultation was 84.39%, and the proportion of non-visiting patients was 15.61%. (2) 71.30% of the patients in two weeks actually visited primary health care units. (3) In the process of developing community health services, establishing appropriate mode of community health service network is the key measure to develop community health services. After the implementation of the network, residents ’demand for community health services has greatly improved their satisfaction. The formal medication and blood pressure control of hypertensive patients has been greatly improved. The rate of community residents’ health knowledge and the rate of bad behavior exposure have obviously changed. (4) Community health education occupies an important position in community health service. From 1999 to 2006, the comprehensive index of community health service was 0.4348,0.4702,0.6206,0.7561,0.7971,0.8613,0.8853,0.9005, showing an increasing trend year by year. From 1999 to 2006, the comprehensive index of community health education was 0.3735,0.4966,0.6140 , 0.7158,0.7574,0.8091,0.8270,0.8418, showing an increasing trend year by year. The correlation between community health service and community health education was statistically significant (r = 0.988, P <0.005). Conclusion The network model that is conducive to helping community residents form a healthy lifestyle and promoting chronic disease management has been constructed in Puyang City. This model has strong practicability and operability. Proposed and proved that “community health education as a carrier, the community health services in-depth” is an effective way to carry out community health services. Established a perfect community health service evaluation system.