社区卫生工作人员付出—回报失衡与分级诊疗支持度的关系研究

目的：研究社区卫生服务中心工作人员对工作付出、回报及付出-回报失衡感受和对分级诊疗支持度之间的关系，并验证工作满意度在其中是否起到了中介作用。方法：选取北京市17家社区卫生服务中心，抽取1 057名工作人员进行问卷调查，使用付出-回报失衡量表测量工作付出、回报、超负荷和付出-回报失衡的情况，用工作满意度量表测量工作满意度，运用多元线性回归和Bootstrap检验对中介作用进行分析和验证。结果：社区卫生工作人员对工作付出与超负荷方面的感受和分级诊疗支持度不相关，在工作回报方面的感受与分级诊疗支持度呈显著正相关（P<0.001），付出-回报失衡与分级诊疗支持度呈显著负相关（P<0.001）。工作满意度在回报与分级诊疗支持度、付出-回报失衡与分级诊疗支持度之间均存在显著的中介作用。结论：社区卫生工作人员的工作回报越高，或付出-回报失衡越低，其工作总体满意度就越高，对分级诊疗的支持度也会越高。

Study on the relationship between community healthcare workers' effort-reward imbalance and their support for hierarchical medical system

Objective:To study the relationship between the effort-reward imbalance and hierarchical medical system support for community healthcare workers and to verify the level of satisfaction and its contribution into the mediation of the situation. Methods:A questionnaire survey was conducted among 1057 staff from 17 community health service centers in Beijing, and the overall effort-reward imbalance was measured by the satisfaction scale taking into account the work effort, return, overload and the pay; which led to the good measurement of job satisfaction. The multivariate linear regression (MLR) and Bootstrap test were used to analyze and verify the mediating effect. Results:The results showed that there was no significant correlation between the work effort or overload perception and the hierarchical medical system support among community healthcare workers. The perception of the remuneration was positively correlated with the support for hierarchical medical system (P<0.001), while the effort-reward imbalance showed a negative correlation (P<0.001). From these results, it was clearly seen that job satisfaction plays a significant mediating effect in both of the above two relationships. Conclusions:The higher the remuneration perceived by community healthcare workers or the lower their pay imbalance, the higher their overall job satisfaction; which could finally increase their support for hierarchical medical system.