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四川省乡镇卫生院基本公共卫生服务工作量和人力需求研究

朱梦蓉 杨先碧 杨珉

朱梦蓉, 杨先碧, 杨珉. 四川省乡镇卫生院基本公共卫生服务工作量和人力需求研究[J]. 四川大学学报(医学版), 2021, 52(5): 783-788. doi: 10.12182/20210960103
引用本文: 朱梦蓉, 杨先碧, 杨珉. 四川省乡镇卫生院基本公共卫生服务工作量和人力需求研究[J]. 四川大学学报(医学版), 2021, 52(5): 783-788. doi: 10.12182/20210960103
ZHU Meng-rong, YANG Xian-bi, YANG Min. Study of the Workload and Human Resources Demand of Basic Public Health Services in Township Hospitals of Sichuan Province[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 783-788. doi: 10.12182/20210960103
Citation: ZHU Meng-rong, YANG Xian-bi, YANG Min. Study of the Workload and Human Resources Demand of Basic Public Health Services in Township Hospitals of Sichuan Province[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 783-788. doi: 10.12182/20210960103

四川省乡镇卫生院基本公共卫生服务工作量和人力需求研究

doi: 10.12182/20210960103
基金项目: 中华医学基金会(No. CMB Grant 16-252,2016–2019)资助
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    通讯作者:

    E-mail:yangmin2013@scu.edu.cn

Study of the Workload and Human Resources Demand of Basic Public Health Services in Township Hospitals of Sichuan Province

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  • 摘要:   目的  了解四川省乡镇卫生院基本公共卫生服务(简称基公服务)工作量情况,为完善基公服务人力资源配置,提升服务质量提供依据。  方法  采用单位时间服务量的实耗工时回顾性调查法,现场调查收集一个经济发达地区和一个经济中等发达地区的7个乡镇卫生院的2018年基公服务数量和人员单位服务工作时间,根据实耗工时测算所需人力。  结果  各项基公服务基本单位耗时变异较大,前4位耗时最多且两地区一致的服务依次是健康教育、卫生监督协管、0~6岁儿童管理和孕产妇管理。经济中等发达地区机构人员除在儿童预防接种建证、高血压患者管理和卫生监督协管任务上人均服务量大于经济发达地区外,其他各项服务量均低于后者。全职人员在两地区均存在短缺。  结论  基公服务量在不同经济水平地区间存在差异,人力资源短缺可能与服务质量的降低和数量减少相关。综合探索人才引入留用政策、强化基层业务培训、优化信息化手段将有助于提升基层服务能力和质量。
  • 表  1  调查机构2018年基本公共卫生人力和服务情况

    Table  1.   Basic public health human resources and services by institution (2018)

    Human resourcesHigh economic development region
    (GDP per capita:145 855 RMB)*
    Moderate economic development region
    (GDP per capita:39 090 RMB)*
    LQALQBLQCLQDTotalFSAFSBFSCTotal
    Number of medical and health worker actually investigated 35 15 32 41 123 16 18 16 50
    Number of medical and health worker approved by the
    administration
    36
    19
    34
    29
    118
    17
    26
    24
    57
    Confirmed number of permanent residents 51400 29666 74000 107000 262066 36300 39200 23913 99413
    Number of resident per medical and health worker services 1428 1561 2176 3690 2221 2135 1508 996 1740
    Cumulative coverage of residents included the health records
    system (%)
    96.4
    99.6
    97.6
    92.6
    95.6
    77.8
    76.5
    99.9
    82.6
     Three township hospitals (LQA, LQB, LQC) and one community health service center (LQD) in Longquanyi District and three township hospitals in Fushun County (FSA, FSB, FSC) were investigated. *Data from local government websites in 2018.
    下载: 导出CSV

    表  2  按服务类别的实耗工作量的地区差别

    Table  2.   Regional differences in actual workload by service category

    (Service No.) Service categoryHigh economic
    development region
    Moderate economic
    development region
    Comparison of
    differences*
    n$ \bar{x}\pm s $, hn$ \bar{x}\pm s $, hMean difference, h (P)
    (S1) New residents’ health records 82 2.73±4.01 33 3.01±2.29 −0.28 (0.708)
    (S2) Health education 63 15.46±16.58 29 23.72±46.85 −8.26 (0.242)
    (S3) Registration of children for vaccination 45 1.40±0.96 28 1.54±1.36 −0.14 (0.522)
    (S4) Management of children aged 0-6
     (S4.1) Newborn home visit 33 1.07±0.87 28 1.71±1.23 −0.64 (0.023)
     (S4.2) Newborn health management 4 weeks after birth 24 0.85±0.80 24 1.21±0.60 −0.36 (0.090)
     (S4.3) Infant health management 25 1.11±0.77 27 1.29±0.78 −0.18 (0.430)
     (S4.4) Health management of preschool children 25 0.99±0.75 25 1.35±0.76 −0.36 (0.092)
    (S5) Maternal care management 33 3.39±1.71 27 4.39±2.67 −1.00 (0.085)
    (S6) Health management of the elderly 72 1.80±1.19 28 3.51±9.37 −1.71 (0.128)
    (S7) Followup management of type-2 diabetes mellitus 72 1.69±1.36 29 1.77±0.94 −0.08 (0.784)
    (S8) Followup management of hypertension 75 1.61±1.29 29 1.70±0.84 −0.09 (0.751)
    (S9) Followup management of severe mental disorders 40 2.24±1.46 29 2.20±1.11 +0.04 (0.146)
    (S10) Followup management of pulmonary tuberculosis 35 1.94±1.28 25 2.41±2.05 −0.47 (0.280)
    (S11) Health management with traditional Chinese medicine 50 1.04±0.84 29 1.34±0.74 −0.20 (0.126)
    (S12) Handling of infectious diseases and public health events 39 1.62±1.24 25 1.59±0.97 +0.03 (0.906)
    (S13) Health supervision and coordination 28 4.57±3.08 23 5.03±4.73 −0.46 (0.677)
     *The statistical test results after logarithmic transformation data were used when the variances of the two groups were not homogeneous.
    下载: 导出CSV

    表  3  基层卫生机构年服务数量和单位服务时间(2018年)

    Table  3.   Annual service volume and unit service time, measured in terms of hours, of primary health care institutions (2018)

    Service categoryAnnual service volume and per capita
    service ratio of institutions
    Unit service hours consumed median (25%-75% quantile value)
    High economic development region, TU1Moderate economic development region, TU2Per capita
    service ratio
    High economic development regionModerate economic development region
    S1 (persons) 11 943 174 33.16 1.90 (1.25-3.02) 2.50 (1.29-4.00)
    S2
     Make annual plan/times 4 3 0.64 1.00 (0.83-1.80) 1.00 (0.50-1.49)
     Health education evaluation/times 4 3 0.64 3.13 (2.33-4.83) 3.50 (2.50-5.00)
    Type of printout materials produced (distributed)/numbers 30 79 0.18 0.50 (0.15-0.96) 0.50 (0.28-0.90)
    Type of audio-visual materials produced (played)/numbers 34 72 0.23 0.50 (0.28-0.91) 0.67 (0.33-1.00)
     Making bulletin board/times 31 50 0.30 0.50 (0.38-0.93) 0.85 (0.42-1.00)
     Replacing bulletin board/times 138 52 1.29 0.29 (0.12-0.47) 0.21 (0.13-0.42)
     Public health consultation activities/times 105 33 1.54 3.50 (2.05-4.58) 3.17 (2.00-6.33)
     Lectures on health knowledge/times 128 38 1.63 3.12 (2.33-4.83) 3.50 (2.50-5.00)
    Individualized health education service/person times 27 841 1 157 11.62 0.60 (0.30-0.97) 0.67 (0.41-0.85)
    S3 (persons) 5 336 4 501 0.57 1.27 (0.53-2.12) 1.24 (0.58-2.01)
    S4
     S4.1 (person times) 5 064 449 5.45 1.00 (0.50-1.42) 1.42 (1.00-2.13)
     S4.4 (persons) 16 725 2 526 3.20 0.83 (0.46-1.42) 1.17 (0.88-1.75)
    S5 (persons) 5 739 447 6.21 3.50 (1.83-4.08) 4.17 (3.33-5.27)
    S6 (person times) 18 056 6 848 1.27 1.54 (1.17-2.06) 1.58 (1.19-2.35)
    S7 (person times) 15 917 5 455 1.41 1.50 (0.95-2.00) 1.67 (1.08-2.29)
    S8 (person times) 24 858 19 836 0.61 1.33 (0.97-1.92) 1.67 (0.98-2.25)
    S9 (person times) 11 134 2 495 2.16 2.00 (1.00-2.92) 1.83 (1.42-2.92)
    S10 (times) 457 146 1.51 1.50 (1.17-2.50) 1.83 (1.17-3.33)
    S11
     People over 65 years old/person times 18 327 6 038 1.47 0.33 (0.25-0.67) 0.50 (0.33-0.67)
     People aged 0-36/person times 11 832 1 167 4.90 0.33 (0.25-0.50) 0.50 (0.33-0.58)
    S12
    Report of infectious diseases and public health emergencies/times 395 28 6.81 0.50 (0.26-0.50) 0.50 (0.29-0.58)
    Information and guidance service for tuberculosis and AIDS patients/times 723 42 8.32 0.50 (0.50-1.00) 0.50 (0.33-0.50)
    S13 (times)
    Inspection on sanitary safety of drinking water/times 186 26 3.46 0.67 (0.50-1.00) 1.00 (0.56-1.87)
     School health service/times 76 72 0.51 1.00 (0.46-1.00) 1.00 (0.67-1.88)
    Illegal medical practice and illegal blood collection and supply/cases 22 62 0.17 0.67 (0.50-1.50) 0.50 (0.50-1.00)
     Visit and report on family planning
      service/times
    4 3 0.64 0.83 (0.50-1.00) 1.00 (0.50-1.00)
    下载: 导出CSV

    表  4  基层卫生机构基公服务年工作总量

    Table  4.   Total annual service volume for basic public health tasks in primary health institutions

    Service categoryHigh economic development region/hModerate economic development region/h
    Median workload (%)Minimum workloadMaximum workloadMedian workload (%)Minimum workloadMaximum workload
    S1 22 691.70 (11.1) 14 928.75 36 067.86 435.00 (0.6) 224.46 696.00
    S2 17 575.50 (8.6) 8 920.79 28 313.21 1 167.46 (1.6) 718.01 1 616.75
    S3 6 776.72 (3.3) 2 828.08 11 312.32 5 581.24 (7.5) 2 610.58 9 047.01
    S4 18 945.75 (9.3) 10 225.50 30 940.38 3 593.00 (4.8) 2 671.88 5 376.87
    S5 20 086.50 (9.8) 10 502.37 23 415.12 1 863.99 (2.5) 1 488.51 2 355.69
    S6 27 806.24 (13.6) 21 125.52 37 195.36 10 819.84 (14.6) 8 149.12 16 092.80
    S7 23 875.50 (11.7) 15 121.15 31 834.00 9 109.85 (12.3) 5 891.40 12 491.95
    S8 33 061.14 (16.2) 24 112.26 47 727.36 33 126.12 (44.6) 19 439.28 44 631.00
    S9 22 268.00 (10.9) 11 134.00 32 511.28 4 565.85 (6.1) 3 542.90 7 285.40
    S10 685.50 (0.3) 534.69 1 142.50 267.18 (0.4) 170.82 486.18
    S11 9 952.47 (4.9) 7 539.75 18 195.09 3 602.50 (4.8) 2 377.65 4 722.32
    S12 559.00 (0.3) 464.20 920.50 35.00 (0.05) 21.98 37.24
    S13 218.68 (0.1) 140.96 299.00 132.00 (0.2) 95.30 248.98
    Total 204 502.70 (100.0) 127 578.00 299 874.00 74 299.00 (100.0) 47 401.89 105 088.20
    下载: 导出CSV

    表  5  基层卫生机构基公服务人力资源需求估计

    Table  5.   estimation of human resource requirements for basic public health tasks in primary health institutions

    Service categoryHigh economic development region/case Moderate economic development region/case
    MedianMinimumMaximumMedianMinimumMaximum
    Expected number of full-time staffs to complete BPHS 102 64 149 37 24 52
    Actual number of approved BPHS workers (difference from the expected number) 118 (+16) 118 (+54) 118 (−31) 57 (+20) 57 (+33) 57 (+5)
    Actual number of full-time public health workers and village doctors (difference from the expected number) * 30 (−72) 30 (−34) 30 (−119) 21 (−16) 21 (−3) 21 (−31)
    Actual number of full-time and estimated part-time workers (difference from expected) ** 61 (−41) 61 (+11) 61 (−88) 36 (−1) 36 (+12) 36 (−16)
     *Full time workers of BPHS; **According to the questionnaire, 26% part-time workers are estimated to have additional full-time service.
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-09-08
  • 修回日期:  2021-03-08
  • 网络出版日期:  2021-12-06
  • 刊出日期:  2021-09-20

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