基层卫生人员非工作范围负担及对策研究

对我国基层卫生机构减负情况进行调查,结果显示：当前基层卫生人员非工作范围的负担主要有督导检查频繁（56.45%）、信息系统整合共享差（48.63%）、填制表格过多（47.31%）等,减负效果并不明显,大部分基层卫生人员表示“没有感受到工作负担减轻”。对此,要从规范督查检查、削减报表填报、整合信息系统等方面入手,切实减轻基层卫生人员非工作范围的负担。     

基层卫生服务人员满意度研究综述

近年来,我国政府对基层卫生日益重视,投入不断增加。要将政府的基层卫生投入转变为有效的服务,基层卫生服务人员的行为至关重要,而满意度是影响其行为的重要因素。总结了目前国内对于基层卫生服务人员满意度的相关研究,为制定适宜的基层卫生服务人员激励机制提供依据。     

贵州省基层医疗机构卫生人员激励因素研究

目的探索贵州省基层医疗机构卫生人员的激励因素,为制定合理激励政策提供科学依据。方法采用因子分析法探讨激励相关因素,提取激励因素的公因子,利用多元线性回归分析影响卫生人员卫生政策整体满意度的激励因素。结果因子分析结果显示,贵州省基层医疗机构卫生人员激励因素可归为社会认同、管理与工作自主权、工作压力、收入、培训发展、工作荣誉感、人际关系及居住条件等八类;多重线性回归结果显示,对卫生人员卫生政策满意度影响的激励因素,从大到小排序依次是收入、管理与工作自主权、培训发展、人际关系、社会认同、工作荣誉感、居住条件。结论针对贵州省基层医疗机构卫生人员应主要采取正强化措施为主的激励措施。     

天津市基层卫生人员现状调查及公平性分析

目的:分析天津市基层医疗卫生机构人才队伍建设现状、存在问题以及产生问题的原因,以期对未来政府制定相关决策提供支持;方法:通过开展基层医疗机构人才队伍现状调查,对基层卫生人员现状及存在问题进行深入分析;结果:目前天津市基层卫生人才队伍存在的问题主要为人员数量短缺、城乡卫生人才分布不均衡、临聘人员比重过高、人员整体素质不高等;结论:进一步加强人才培养,改革人才培养及引进机制,促进卫生人才在城乡的合理流动,进一步提升基层医疗卫生人员的业务技术水平,探索建立针对基层卫生人员的专业化的职称评定体系。     

全国卫生监督机构人员岗位分布情况

目的了解卫生监督人员岗位分布情况,为探索人岗匹配条件提供依据。材料与方法通过普查,获取全国卫生监督人员的基本资料,应用SPSS16.0软件对数据进行统计分析。结果 (1)分类别来看,卫生监督人员岗位分布主要集中于卫生执法类(69.34%),从具体岗位来看,综合监督的人员数最多(26.31%);(2)学历水平方面,从事综合业务类人员学历水平最高,大学以上学历比例为44.99%,具有学位人数的比例为44.82%;(3)4类岗位的人员所学专业分布上有所差异。结论 (1)岗位人员配置比例基本合理;(2)不同岗位人员学历水平、专业结构基本满足岗位要求。     

论基层卫生防疫站卫生检验工作的建设

卫生检验室是卫生防疫站进行科学实验的主要场所。其机构的设置，检验人员的素质，仪器的配备，决定了一个防疫站的检验水平。     

基层卫生人员内在动机对工作绩效的影响研究——工作满意度的中介作用

目的：分析基层卫生人员工作激励对工作绩效的影响以及工作满意度的中介作用。方法：选取1324名基层卫生人员进行问卷调查,采用多元线性回归模型分析内在动机、工作满意度与工作绩效之间的关系。结果：年龄、文化程度、婚姻状况、工作岗位、内在动机和满意度是任务绩效的主要影响因素;年龄、婚姻状况、内在动机和满意度是关系绩效的主要影响因素;工作岗位、内在动机和满意度是学习绩效的主要影响因素。满意度在内在动机和任务绩效、关系绩效和学习绩效间均起部分中介作用,中介效应百分比分别为35.7%、29.5%和26.1%。结论：增强基层卫生人员内在动机既可直接提高其工作绩效,也能通过增加工作满意度间接提高其工作绩效。管理者应重视内部激励,激发基层卫生人员的积极性与主动性,以吸引和留住基层卫生人员。     

基层卫生人员医疗卫生知识水平测试分析

目的分析基层卫生人员医疗卫生知识测试成绩,为提高基层卫生人员素质能力提供参考依据。方法于2011年5—6月对山东、吉林、安徽、陕西及重庆5省(直辖市)的850名基层卫生人员进行基本医疗卫生知识的闭卷笔试,对测试平均分和及格率进行统计描述和单因素分析。结果医生平均分为(60.13±9.30)分,护士平均分为(61.69±9.38)分,防保人员平均分为(63.49±10.01)分;学历水平越高的医生测试成绩越好,工作6～15年的卫生人员成绩较好。结论基层卫生人员对医疗卫生知识掌握水平较差,可通过吸引高校毕业生到基层就业及进行有针对性的在职培训等措施提高卫生人员的整体素质。     

绩效管理对基层卫生人员工作绩效的影响机制研究——工作动机的中介作用

目的：分析基层医疗卫生机构绩效管理制度运行现状,探究绩效管理对基层卫生人员工作绩效的影响及其作用机制。方法：采用多阶段整群抽样,对山东省青岛、东营与枣庄三市18家社区卫生服务中心和20家乡镇卫生院的基层卫生人员进行问卷调查和个人深入访谈,共计回收有效问卷870份,访谈175人。结果：绩效管理各维度(考核规范性、考核意义感、反馈及时性、分配公平性)中,有三个维度给予正面评价的人员比例未过半数,对四个维度给予负面评价的人员比例均在10%～20%之间,其中分配公平性的得分相对最低。绩效管理对任务绩效无显著影响,对关系绩效与学习绩效有显著弱影响。卫生人员工作动机的主导类型为控制性动机,工作动机在绩效管理要素和工作绩效之间起完全中介作用,且自主性动机对关系绩效和学习绩效的影响强于控制性动机。结论：当前基层医疗卫生机构绩效管理存在指标设置不合理、考核过程形式化、考核结果反馈不及时等问题,激励作用有限,对基层卫生人员工作绩效影响较弱。为此,应通过制定合理的考核指标、加强针对考核结果的沟通与反馈、发挥绩效工资的激励作用、培育发展性的绩效管理文化等举措完善基层医疗卫生机构绩效管理,提高基层卫生人员工作动机与绩效。     

基层卫生人员心理契约和离职倾向对工作绩效影响机制及作用路径研究

目的：研究基层卫生人员心理契约、离职倾向对其工作绩效的影响机制,探析离职倾向在其中的中介作用,明晰三者之间的作用路径,为基层卫生人力队伍建设提供依据。方法：对南京市浦口区基层卫生人员进行问卷调查,收集相关社会人口学信息,测量心理契约、离职倾向和工作绩效水平,拟合多重线性回归模型分析影响机制,采用结构方程模型明确三者间的作用路径。结果：基层卫生人员的心理契约对其工作绩效存在正向促进作用(β=0.537,P<0.001),纳入中介变量离职倾向后发现,心理契约仍对工作绩效存在正向促进作用(β=0.242、P均<0.001),其直接效应的标准化路径系数为0.362;离职倾向总分对工作绩效有负向影响,即离职倾向越高,工作绩效越低(标准化路径系数β=-0.388,P<0.001)。结论：重视基层卫生人员内在诉求,在绩效考核公平性等其内在诉求方面加强建设;提升基层卫生人员薪酬福利待遇、提供事业发展机会和塑造良好的人际关系等工作环境氛围是降低离职倾向的重要抓手;要从系统和整体的思维出发,多措并举、系统解决好基层卫生事业发展所面临的突出问题,实现基层卫生高质量发展。     

医生工作时长与医疗差错的相关性研究

目的:了解临床医生的工作时长与医疗差错之间的相关性,为提高医疗服务质量提供科学依据。方法:2018.1~2018.4,采用问卷调查法进行资料收集,在湖北省内抽取了8家医院临床医生作为调查研究对象,回收问卷555份,运用描述性及卡方检验的统计学方法进行相关性分析。结果:调查结果显示,89.65%的临床医生每周工作时长>40小时,22.27%的临床医生在近6个月内发生过医疗差错。工作时长、文化程度、熬夜和加班情况与医疗差错事件的发生具有显著相关性(P<0.05),且每周工作时长会显著影响治疗差错、病案书写差错以及用药差错的发生。结论:为减少医疗差错事件的发生,应控制医生工作时长,保障充足的休息时间。     

The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea

ObjectivesAlthough Korea issued a law and developed benefits of National Health Insurance (NHI) to enable the provision of home-based primary care (HBPC) along with implementation of a pilot project for community care for older adults in August 2019, the outcomes of HBPC services were not surveyed in Korea. This study aimed to assess the outcomes of HBPC among older adults.DesignAnalyses were conducted using data from the National Health Insurance Service in connection with administrative survey data. Difference-in-differences analysis was performed using a generalized estimating equation and Cox proportional hazards model.Setting and ParticipantsOverall, 538 older adults who used HBPC services in a pilot project for community care and 2059 propensity score–matched older individuals who did not use HBPC services in Korea were included.MethodsThe length of home stay, total costs of NHI, hospitalizations, and admission to long-term care (LTC) facilities were measured as outcomes, and the outcomes of the participants were compared to those of the control group.ResultsThe findings indicated an increase of 8.3 days (95% CI 2.1-14.5) in the length of home stay and a reduction of US$1241 (95% CI −2342 to −139) in total costs of NHI among older adults who used HBPC services compared to the control group. The odds ratio for rates of hospitalization among older adults who utilized HBPC services was 0.77 (95% CI 0.60-0.98) and the hazard ratio for the admission of LTC facilities was 0.12 (95% CI 0.04-0.32) in comparison to the control group.Conclusions and ImplicationsThe HBPC intervention has resulted in an increased length of home stay and reduced total costs, hospitalizations, and admission to LTC facilities among Korean older adults. In the future, new HBPC models must be developed to provide interprofessional team–based HBPC services with a standardized protocol of service provision.     

Successful Implementation of Integrated Care in Slovenian Primary Care

For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.     

Preventive Psychology in Primary Care Settings

This article will describe some of the more promising types of preventive interventions that exist in primary health care settings. It will present a rationale for practicing psychologists to consider issues of prevention when working in health care settings. Approaches to prevention and the integration of preventive measures into primary care will be presented, as well as examples of the implementation of innovative prevention programs. This article will conclude with examples and recommendations for primary care psychologists who wish to become more involved with prevention.Editors Strategic Implications: The authors provide useful information and suggestions both for individual psychologists interested in focusing on individual-level interventions, as well as larger-scale interventions that present more challenges to implement, but also provide greater benefits to community health and well-being. Health care professionals and administrators could discern why and how to involve psychologists in their prevention efforts.     

Large Independent Primary Care Medical Groups

PURPOSEIn the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges.METHODSWe identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes.RESULTSThe groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale.CONCLUSIONSLarge, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.     

居民就医选择与基层医疗机构的竞争性分析

目的探索影响城乡居民选择基层医疗机构就诊的影响因素,并为基层医疗机构发展提出建议。方法采用Logistic回归对中国健康与营养调查2009年截面数据进行分析。结果疾病严重程度、医疗保险状况、有无工作以及户籍是影响居民选择基层医疗机构就诊的关键因素。结论应当针对这些方面对目前政策做出调整以增强基层医疗机构竞争力。     

Effect of Primary Care Visits on the Demand for Specialty Care in Health Maintenance Organizations

Health maintenance organizations (HMOs) provide low cost access to primary care physicians (PCPs) in an effort to restrict expensive specialty use. Although managed care plans hope that low cost primary care will reduce specialist use, the theoretical effect of easing access to primary care on specialty use is unclear. Despite the importance of estimating the effect of PCP visits on specialty use, no previous studies have directly addressed this question at the enrollee level. This study examines the effect of visits to the PCP on the demand for episodes of specialty care in two health plans: a gatekeeper HMO and a point-of-service plan. Using person-level data, we estimate a generalized method of moments model of specialty episodes that accounts for the endogeneity of PCP visits within a count-data framework. We compare this model to three alternative models—an OLS model, a negative binomial model, and a two-stage least squares model. We find evidence that increases in primary care visits increase episodes of specialty care in both plans. We also find that the three alternative models yield biased but more efficient estimates compared to the generalized method of moments model.This revised version was published online in June 2005 with a corrected cover date.