中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
28期
3405-3409
,共5页
吴燕%王君燕%黄晓霞%许慧琳%苏华林%赵燕萍
吳燕%王君燕%黃曉霞%許慧琳%囌華林%趙燕萍
오연%왕군연%황효하%허혜림%소화림%조연평
家庭医生服务%公共卫生服务%服务模式%效果评价
傢庭醫生服務%公共衛生服務%服務模式%效果評價
가정의생복무%공공위생복무%복무모식%효과평개
Family doctor service%Public health service%Service model%Effectiveness evaluation
目的：探讨上海市闵行区家庭医生责任制下不同公共卫生服务模式的效果。方法采用典型抽样法，在闵行区实施3种不同公共卫生服务模式的社区卫生服务中心中各抽取1家社区卫生服务中心，以其公共卫生服务模式为研究对象。3种公共卫生服务模式分别为：借助社区卫生服务站依托全科医生团队管理的传统型服务模式（模式1）、依托家庭医生／公共卫生外包中心协同管理的渐进型服务模式（模式2）、依托全科医生／医生助理小团队管理的激进型服务模式（模式3）。评价2014年3种不同公共卫生服务模式的卫生人力成本、公共卫生工作效率及服务效果。结果3种模式每10万管理人口中分配的公共卫生服务人员数相近，分别为61.22、61.37、61.91人。模式1中，公共卫生人员投入比例最大，占14.53％；模式3中，全科医生及医生助理投入比例最大，占40.10％；模式2中，公共卫生人员、家庭医生及医生助理投入比例分别为10.96％、30.82％。3种模式的居民家庭电子健康档案建档率、免疫规划疫苗接种率、高血压管理率、糖尿病管理率、健康教育覆盖率、60岁以上老年人体检覆盖率、孕产妇系统管理率、0～6岁儿童系统管理率、精神疾病患者规范管理率及学生疾病规范管理率比较，差异均有统计学意义（P＜0.05）；3种模式的两两比较中，除模式1与模式2的精神疾病患者规范管理率（P＝0.034）、学生疾病规范管理率（P＝0.460）和模式2与模式3的学生疾病规范管理率（P＝0.232）间差异无统计学意义外，其余差异均有统计学意义（P＜0.0167）。3种模式的甲乙类传染病发病率、高血压血压有效控制率、糖尿病血糖有效控制率比较，差异均有统计学意义（P＜0.05）；3种模式的两两比较中，除模式1与模式3的甲乙类传染病发病率（P＝0.718）间差异无统计学意义外，其余差异均有统计学意义（P＜0.0167）。结论在服务相同人口的情况下3种模式投入相同的卫生人力成本，以模式2的公共卫生服务效率、服务效果较好，模式3在慢性病管理方面的效果较好。模式2公共卫生服务更均衡化，是现阶段推进社区公共卫生管理模式改革的较好选择；而模式3将是今后社区公共卫生服务发展的方向。
目的：探討上海市閔行區傢庭醫生責任製下不同公共衛生服務模式的效果。方法採用典型抽樣法，在閔行區實施3種不同公共衛生服務模式的社區衛生服務中心中各抽取1傢社區衛生服務中心，以其公共衛生服務模式為研究對象。3種公共衛生服務模式分彆為：藉助社區衛生服務站依託全科醫生糰隊管理的傳統型服務模式（模式1）、依託傢庭醫生／公共衛生外包中心協同管理的漸進型服務模式（模式2）、依託全科醫生／醫生助理小糰隊管理的激進型服務模式（模式3）。評價2014年3種不同公共衛生服務模式的衛生人力成本、公共衛生工作效率及服務效果。結果3種模式每10萬管理人口中分配的公共衛生服務人員數相近，分彆為61.22、61.37、61.91人。模式1中，公共衛生人員投入比例最大，佔14.53％；模式3中，全科醫生及醫生助理投入比例最大，佔40.10％；模式2中，公共衛生人員、傢庭醫生及醫生助理投入比例分彆為10.96％、30.82％。3種模式的居民傢庭電子健康檔案建檔率、免疫規劃疫苗接種率、高血壓管理率、糖尿病管理率、健康教育覆蓋率、60歲以上老年人體檢覆蓋率、孕產婦繫統管理率、0～6歲兒童繫統管理率、精神疾病患者規範管理率及學生疾病規範管理率比較，差異均有統計學意義（P＜0.05）；3種模式的兩兩比較中，除模式1與模式2的精神疾病患者規範管理率（P＝0.034）、學生疾病規範管理率（P＝0.460）和模式2與模式3的學生疾病規範管理率（P＝0.232）間差異無統計學意義外，其餘差異均有統計學意義（P＜0.0167）。3種模式的甲乙類傳染病髮病率、高血壓血壓有效控製率、糖尿病血糖有效控製率比較，差異均有統計學意義（P＜0.05）；3種模式的兩兩比較中，除模式1與模式3的甲乙類傳染病髮病率（P＝0.718）間差異無統計學意義外，其餘差異均有統計學意義（P＜0.0167）。結論在服務相同人口的情況下3種模式投入相同的衛生人力成本，以模式2的公共衛生服務效率、服務效果較好，模式3在慢性病管理方麵的效果較好。模式2公共衛生服務更均衡化，是現階段推進社區公共衛生管理模式改革的較好選擇；而模式3將是今後社區公共衛生服務髮展的方嚮。
목적：탐토상해시민행구가정의생책임제하불동공공위생복무모식적효과。방법채용전형추양법，재민행구실시3충불동공공위생복무모식적사구위생복무중심중각추취1가사구위생복무중심，이기공공위생복무모식위연구대상。3충공공위생복무모식분별위：차조사구위생복무참의탁전과의생단대관리적전통형복무모식（모식1）、의탁가정의생／공공위생외포중심협동관리적점진형복무모식（모식2）、의탁전과의생／의생조리소단대관리적격진형복무모식（모식3）。평개2014년3충불동공공위생복무모식적위생인력성본、공공위생공작효솔급복무효과。결과3충모식매10만관리인구중분배적공공위생복무인원수상근，분별위61.22、61.37、61.91인。모식1중，공공위생인원투입비례최대，점14.53％；모식3중，전과의생급의생조리투입비례최대，점40.10％；모식2중，공공위생인원、가정의생급의생조리투입비례분별위10.96％、30.82％。3충모식적거민가정전자건강당안건당솔、면역규화역묘접충솔、고혈압관리솔、당뇨병관리솔、건강교육복개솔、60세이상노년인체검복개솔、잉산부계통관리솔、0～6세인동계통관리솔、정신질병환자규범관리솔급학생질병규범관리솔비교，차이균유통계학의의（P＜0.05）；3충모식적량량비교중，제모식1여모식2적정신질병환자규범관리솔（P＝0.034）、학생질병규범관리솔（P＝0.460）화모식2여모식3적학생질병규범관리솔（P＝0.232）간차이무통계학의의외，기여차이균유통계학의의（P＜0.0167）。3충모식적갑을류전염병발병솔、고혈압혈압유효공제솔、당뇨병혈당유효공제솔비교，차이균유통계학의의（P＜0.05）；3충모식적량량비교중，제모식1여모식3적갑을류전염병발병솔（P＝0.718）간차이무통계학의의외，기여차이균유통계학의의（P＜0.0167）。결론재복무상동인구적정황하3충모식투입상동적위생인력성본，이모식2적공공위생복무효솔、복무효과교호，모식3재만성병관리방면적효과교호。모식2공공위생복무경균형화，시현계단추진사구공공위생관리모식개혁적교호선택；이모식3장시금후사구공공위생복무발전적방향。
Objective To investigate the effect of three public health service models within family doctor responsibility system.Methods Using typical sampling method , we selected one community health service center of each of the three public health service models in Minhang District of Shanghai.We conducted investigation on the three public health service models including conventional service model based on community health service station and the management of general practitioner team (model 1), progressive service model based on cooperative management service by family doctors and public health outsourcing centers ( model 2) and advanced service model based on small teams of general practitioners and doctor assistants ( model 3) .Evaluation was made on human cost , work efficiency and service effect of the three models.Results For the three models, the numbers of public health service personnel allocated for every 100 000 residents were 61.22, 61.37 and 61.91 respectively.Model 1 had the largest proportion of public health personnel input which was 14.53%, model 3 has the largest proportion of general practitioners and doctor assistants which was 40.10%, and model 2 had a proportion of 10.96%for public health personnel and 30.82%for family doctors and doctor assistants.The three models were significantly different (P<0.05) in the rates of household electronic health record , vaccination , hypertension management , diabetes management , coverage of health education , coverage of physical examination for residents older than 60 years old, systematic management of pregnant and lying-in women, systematic management of children aged 0 -6 years old, standard management of mentally ill patients and standard management of students′diseases.By pairwise comparison among the three models , model 1 and model 2 were not significantly different in the rate of standard management of mentally ill patients ( P =0.034 ) and the rate of standard management of students′diseases (P=0.460), and there was no significant difference among model 2 and model 3 in the rate of standard management of students′diseases ( P=0.232 ) , apart from which significant differences were found in all the other items among the three groups ( P<0.016 7 ) .The three models were significantly different ( P<0.05 ) in the prevalence of infectious diseases of class A and class B , the effective control rate of hypertension and the effective control rate of diabetic blood sugar; by pairwise comparison among the three models , significant difference (P<0.016 7) was found in all items except that no significant difference (P=0.718) was found between model 1 and model 3 in the prevalence of infectious diseases of class A and class B.Conclusion Given the same health human cost and serving the same population , model 2 provides more efficient public health services and better effects.Model 3 has more advantages in chronic disease controlling and prevention.Cooperative management-based service by general practitioners and public health outsourcing centers ( model 2) is better in terms of public health service balance , thus it may be a better choice for reforming community public health services.Small team-based service composed of general practitioners and doctor assistants ( model 3 ) may be the future direction of the public health services in community health service centers.
