【作者】 刘稳；

【导师】 李士雪；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2016， 硕士

【摘要】 研究目的通过张店区社区卫生服务机构发展现状和群众满意度调查,分析张店区社区卫生发展过程中存在的问题和障碍,进一步探讨其社区卫生服务发展的影响因素,依据国家及省、市各级政府基层卫生发展目标规划和社区卫生工作具体要求,结合张店区区情,提出社区卫生服务发展规划要求,构建规划蓝图,为促进张店区社区卫生服务体系进一步发展,提高居民健康水平提供科学依据。资料与方法本研究通过文献复习法,了解我国政府社区卫生发展规划的各项要求,吸取国内外先进社区卫生发展经验；通过问卷调查法,收集居民对张店区社区卫生服务工作的满意度资料,结合山东省卫生统计年鉴、淄博统计年鉴、淄博卫生统计年鉴数据资料,对张店区社区卫生发展现状进行描述分析；通过个人访谈法和专家小组讨论法,总结张店区社区卫生工作存在的障碍,为规划制定提供实证资料。主要研究结果1.张店区社区卫生服务发展存在的问题社区卫生服务机构布局不合理；机构建设不达标；财政投入不足,机构运营经济压力大；卫生人力资源配备不合理；政府政策机制不健全；分级诊疗运行机制有待完善；基本医疗和公共卫生服务能力亟待提升。2.张店区社区卫生服务发展的影响因素国家政策环境和社会发展状况(国家相关政策、社会经济发展、人口形势变化、居民生活方式变化)；社区卫生发展规划和标准要求(国家及省、市政府层面)；地理空间分布因素(城市空间资源因素、人口密度因素、医疗机构分布因素)；居民医疗服务使用因素(医疗服务需求、患者就诊倾向、居民满意度)。对策与建议1.规划要求保留规模和设施设备达到标准要求的9个社区卫生服务中心和58个社区卫生服务站,对未达标的机构进行原址扩建、整体搬迁或撤销(其中1个社区卫生服务站升级为中心、迁址1个、扩建1个；社区卫生服务站撤销2个、迁址6个、扩建1个)。对于缺少社区卫生服务机构的区域,进行土地规划,拟新建社区卫生服务中心1个,乡镇卫生院转型为社区卫生服务中心6个,新建社区卫生服务站7个。最终张店区共规划社区卫生服务机构总数89个,其中社区卫生服务中心19个,社区卫生服务站70个,各机构按照国家要求进行标准化建设。发挥社会力量举办社区卫生服务机构,要求至2020年,张店区由社会力量主办的社区卫生床位数以及服务总量比例不低于25%,并在城市远期社会发展规划中为社会办社区卫生机构预留空间和床位比例不低于30%。完善社区卫生服务功能,要求至2020年,居民对社区卫生机构满意度达95%。转变社区卫生服务模式,推行签约服务,至2017年,要求社区全科医师的签约覆盖率不低于30%,至2020年实现社区全科医师签约全覆盖；积极为特殊人群(老年人、重性精神疾病患者、残疾人等)提供服务,保证老年保健管理率不低于65%,加强妇女保健工作,落实计划生育服务。推进分级诊疗,建立医疗机构间上下联动机制,2016年,各机构开始进行糖尿病、高血压的病例分级诊疗试点相关工作,因地制宜地探索分级诊疗的操作方式；至2017年,基本形成不同医疗机构合作模式,提升社区诊疗比例至6-7%,基本形成“基层首诊、双向转诊、急慢分治、上下联动”的城市分级诊疗模式。加强社区卫生人才队伍建设,至2020年,要求共增加社区全科医师57人,预防保健人员118人,公共卫生医师40人,中医师13人,分配至新建社区卫生服务机构和人员服务能力不足的社区卫生服务中心。充分发挥社区中医药服务优势,至2017年,要求社区卫生服务机构中医诊疗量比例超过30%,中心“国医堂”建成率100%。2.政策保障措施坚持政府主导,落实责任分工；探索新型社区卫生监管体制；落实财政投入政策,确保经费足额到位；完善医保政策,健全社会救助制度。更多还原

【Abstract】 ObjectsTo analyze the development problems or obstacles facing by the community health service development in Zhangdian district and then finds out its affecting factors in the process of developing. To Put forward the development planning requirements and blueprint with the instructions of national and provincial governments’requirements in these years. In the end, this study might be used to provide a scientific basis for the promotion of community health service development and the improvement the health of residents.Materials and MethodsIn this study, literature review method was used to understand the government’s planning requirements on community health development and to learn the advanced experience of community health development at home and abroad; the information of residents’satisfaction on community health work in Zhangdian District was collected via the questionnaire we designed. Health Statistics Yearbook of Shandong Province, Zibo statistical Yearbook, Zibo health statistics Yearbook data were also used for descriptive analysis to help us make a deep understand of the status of community health development in Zhangdian; Research and expert panel discussion were used to summarize the obstacles exists in the development process.The main results1. Problems exit in community health service development of Zhangdian district The problems including the irrational distribution of community health services institutions, below-standard institution building, and not enough compensation funds give rise to the institutions operator economic pressure, unreasonable human resources allocation for health, unsmooth medical referral channel, imperfect policy mechanism, and the incapability of basic medical and public health services. First influencing factor is the national policy environment and social development, which include the national health reform policies, socio-economic development, demographic changes in the situation and residents of lifestyle changes. Then the community health development plans and standards may also influence the development of community health service. The third one is the geospatial distribution factors such as urban space resources, population density factors, and medical factors distribution institutions. Then the use styles of medical services among citizens also important factors which affecting the community health service.Countermeasures and SuggestionsThe standard 9 community health service centers and 58 community health service stations will be reserved. Then one of the stations should be upgraded to center. The other change including 1 center reposition,1 center expansion and 2 stations being canceled,6 stations reposition 1 station expansion. For areas lack of community health services, this study plan to build a new center and 7 stations with 6 township hospitals transition into centers at the same time. There will be 19 centers and 70 stations totally. All the agencies should standardize the construction in accordance with national requirements.Social capital organized community health agencies should be encouraged in the next years. The proportion of beds and services funded by the social forces should be no less than 25%. In the long-term plan,30% spaces should be reserved for the social institutions.To improve the quality of community health services which include the basic medical and the public health services. The rate of resident’ satisfaction to community health services should be more than 95% in 2020.Transform the service model in the health service agencies. Try to implement contractual services. General practitioners contracted coverage no less than 30% of all the services in 2017. And then fulfill the whole coverage of general practitioners in 2020.Promote the hierarchical treatment system in Zhangdian district. The grading pilot treatment of diabetes and hypertension should be launched in 2016. To the year of 2017, the basic mode of coordination among different medical institutions would be formed. The proportion of community health services in the whole health services should be raised to 6-7%.Strengthen the work of community health personnel construction. There should be an additional 57 community general practitioners,118 preventive health care staff,40 public health physicians and 13 Traditional Chinese Medicine practitioners. All the added health service staff should be assigned to the new community health service institutions or the community health service centers with inadequate personnel.Make a full use of the Chinese medicine services in the next period. The proportion of Traditional Chinese Medicine services should be no less than 30% in 2017. All the community health service centers should run the department of Guo Yi Tang, and the proportion of its Traditional Chinese Medicine services should be up to 30%.2. Policy support measuresAdhere to the discipline of government-led, and to implement the division of responsibilities were the most important measures in the process of developing community services. And new community health regulatory system should be explored in the next few years. The third measure is to increase the financial investment with a strictly management of the expenditure. High practical health insurance social assistance policy is also important as we mentioned in this study.更多还原