CAJ | 학술논문

背景随着宫颈癌和乳腺癌发病率的逐年升高，原国家卫生部在全国开展了宫颈癌和乳腺癌筛查的试点工作。目的了解四川省基层医疗卫生服务机构开展宫颈癌和乳腺癌筛查的能力。方法2011年6月-2012年6月，通过查阅文献、专题小组讨论和德尔菲法获得调查指标；通过收集既往资料、现场观察、电话访问获取四川省71家基层医疗卫生服务机构的相关信息，对基层医疗卫生服务机构的基本情况及开展宫颈癌、乳腺癌筛查的人力资源、仪器设备、技术能力进行调查，并比较不同经济水平地区和不同地貌地区机构的差异。结果高国内生产总值（ GDP）组较低GDP组业务用房面积大（P＜0.05），平坝组床位数较丘陵组、山区组多（P＜0.05）；高GDP组年门急诊诊疗人次数较低GDP组多（P＜0.05），不同地貌地区年门急诊诊疗人次数间差异无统计学意义（P＞0.05）。高GDP组在岗工作人员、卫生技术人员、大专及以上学历人员、执业医师、注册护士、中/西医药师（士）、检验和影像技师（士）均多于低GDP组，平坝组的上述人员多于丘陵组和山区组（ P＜0.05）。71家机构中，67家配置有妇科检查床及器械，9家配置了乳腺高频超声，3家配置了细胞学检测器材，3家配置了近红外线，1家配置了阴道镜，各机构均未配置人乳头瘤病毒（ HPV）-DNA和钼靶X线检测设备；10家机构开展过宫颈癌筛查，5家机构开展过乳腺癌筛查。共39家机构建立了居民健康档案，高GDP组居民健康档案建立率高于低GDP组，平坝组高于丘陵组和山区组（P＜0.05）。结论目前四川省基层医疗卫生服务机构开展宫颈癌和乳腺癌筛查的能力较弱，只能够承担起宫颈癌和乳腺癌筛查项目中组织动员和初步筛查的任务，建议通过合理提高和配置卫生人力资源，加强基层医疗卫生服务机构筛查宫颈癌和乳腺癌的能力。揹景隨著宮頸癌和乳腺癌髮病率的逐年升高，原國傢衛生部在全國開展瞭宮頸癌和乳腺癌篩查的試點工作。目的瞭解四川省基層醫療衛生服務機構開展宮頸癌和乳腺癌篩查的能力。方法2011年6月-2012年6月，通過查閱文獻、專題小組討論和德爾菲法穫得調查指標；通過收集既往資料、現場觀察、電話訪問穫取四川省71傢基層醫療衛生服務機構的相關信息，對基層醫療衛生服務機構的基本情況及開展宮頸癌、乳腺癌篩查的人力資源、儀器設備、技術能力進行調查，併比較不同經濟水平地區和不同地貌地區機構的差異。結果高國內生產總值（ GDP）組較低GDP組業務用房麵積大（P＜0.05），平壩組床位數較丘陵組、山區組多（P＜0.05）；高GDP組年門急診診療人次數較低GDP組多（P＜0.05），不同地貌地區年門急診診療人次數間差異無統計學意義（P＞0.05）。高GDP組在崗工作人員、衛生技術人員、大專及以上學歷人員、執業醫師、註冊護士、中/西醫藥師（士）、檢驗和影像技師（士）均多于低GDP組，平壩組的上述人員多于丘陵組和山區組（ P＜0.05）。71傢機構中，67傢配置有婦科檢查床及器械，9傢配置瞭乳腺高頻超聲，3傢配置瞭細胞學檢測器材，3傢配置瞭近紅外線，1傢配置瞭陰道鏡，各機構均未配置人乳頭瘤病毒（ HPV）-DNA和鉬靶X線檢測設備；10傢機構開展過宮頸癌篩查，5傢機構開展過乳腺癌篩查。共39傢機構建立瞭居民健康檔案，高GDP組居民健康檔案建立率高于低GDP組，平壩組高于丘陵組和山區組（P＜0.05）。結論目前四川省基層醫療衛生服務機構開展宮頸癌和乳腺癌篩查的能力較弱，隻能夠承擔起宮頸癌和乳腺癌篩查項目中組織動員和初步篩查的任務，建議通過閤理提高和配置衛生人力資源，加彊基層醫療衛生服務機構篩查宮頸癌和乳腺癌的能力。
배경수착궁경암화유선암발병솔적축년승고，원국가위생부재전국개전료궁경암화유선암사사적시점공작。목적료해사천성기층의료위생복무궤구개전궁경암화유선암사사적능력。방법2011년6월-2012년6월，통과사열문헌、전제소조토론화덕이비법획득조사지표；통과수집기왕자료、현장관찰、전화방문획취사천성71가기층의료위생복무궤구적상관신식，대기층의료위생복무궤구적기본정황급개전궁경암、유선암사사적인력자원、의기설비、기술능력진행조사，병비교불동경제수평지구화불동지모지구궤구적차이。결과고국내생산총치（ GDP）조교저GDP조업무용방면적대（P＜0.05），평패조상위수교구릉조、산구조다（P＜0.05）；고GDP조년문급진진료인차수교저GDP조다（P＜0.05），불동지모지구년문급진진료인차수간차이무통계학의의（P＞0.05）。고GDP조재강공작인원、위생기술인원、대전급이상학력인원、집업의사、주책호사、중/서의약사（사）、검험화영상기사（사）균다우저GDP조，평패조적상술인원다우구릉조화산구조（ P＜0.05）。71가궤구중，67가배치유부과검사상급기계，9가배치료유선고빈초성，3가배치료세포학검측기재，3가배치료근홍외선，1가배치료음도경，각궤구균미배치인유두류병독（ HPV）-DNA화목파X선검측설비；10가궤구개전과궁경암사사，5가궤구개전과유선암사사。공39가궤구건립료거민건강당안，고GDP조거민건강당안건립솔고우저GDP조，평패조고우구릉조화산구조（P＜0.05）。결론목전사천성기층의료위생복무궤구개전궁경암화유선암사사적능력교약，지능구승담기궁경암화유선암사사항목중조직동원화초보사사적임무，건의통과합리제고화배치위생인력자원，가강기층의료위생복무궤구사사궁경암화유선암적능력。
Background With the increase of cervical and breast cancers,China's Ministry of Health had launched a nationwide pilot screening for women. Objectives To know the abilities of primary medical services to screen cervical and breast cancers in Sichuan Province. Methods From June 2011 to June 2012,the survey indexes were obtained through literature con-sulting,group discuss and by Delphi methods. The relevant information of 71 primary medical services were acquired by collec-ting past data,field observation,telephone interview. The basic information,human resources,instruments and equipments, technical capacity of primary medical services were investigated,and the differences were compared between the institutions in ar-eas at different economic levels and in those with different landforms. Results The area for working rooms was larger in high GDP group than in low GDP group,and larger in flatland group than in groups of hill and mountain(P<0. 05). The annual mean person/time at clinics were more in high GDP group than low GDP group(P<0. 05),and there was no significant differ-ence between institutions in areas with different landforms(P>0. 05). The number of on-duty staff,health workers,those with educational levels of junior college or higher,certificated physicians,registered nurses,pharmacists,technicians of check and image was bigger in high GDP group than in low GDP group,bigger in flatland group than in groups of hill and mountain( P<0. 05). In 71 investigated institutions,67 had gynecological examining tables and instruments,9 had breast high-frequency ultrasound,3 had cytological checkout equipments,3 had near infrared ray,1 had colposcope,all had not HPV-DNA or tar-get X ray equipments;10 carried out cervical cancer screening,5 had breast cancer screening. 39 had established resident health records,the rate of health records were higher in high GDP group than in low GDP group,higher in flatland group than in groups of hill and mountain(P<0. 05). Conclusion At present,the ability of primary medical services to screen cervical and breast cancers is insufficient in Sichuan Province. They could undertake only the tasks of organization and mobilization,prelimi-nary screening. Health human resources should be improved and well-allocated to strengthen the ability of primary medical insti-tutions to screen cervical and breast cancers.