我国基层医务人员工作满意度调查及影响因素分析

目的 了解我国基层医务人员工作满意度水平,探索影响因素,提出针对性建议。方法 采用多阶段分层整群抽样方法,于2019年1月-4月,利用自行设计问卷对900名基层医务人员进行问卷调查。运用单因素方差分析、Person相关分析和Logistic回归分析研究基层医务人员满意度影响因素。结果 回收有效问卷865份。基层医务人员总体满意度得分为（3.64±0.82）分。年龄、晋升制度、收入水平、医患关系、绩效考核、工作能力对总体满意度的影响有统计学意义(P<0.05)。结论 基层医务人员总体工作满意度处于一般水平。建议通过提高基层医务人员薪酬待遇,提供良好个人发展空间;增加药品及医疗设备种类,提高社区卫生机构服务能力;优化顶层设计,减轻基层医务人员负担等来提高医务人员总体满意度。     

Sources of regional variation in healthcare utilization in Germany

We examine sources of regional variation in ambulatory care utilization in Germany. We exploit patient migration to examine which share of regional variation in ambulatory care utilization can be attributed to demand factors and to supply factors, respectively. Based on administrative claim-level data we find that regional variation can be overwhelmingly explained by patient characteristics. Our results contrast with previous results for other countries, and they suggest that institutional rules in Germany successfully constrain supply-side variation in ambulatory care use between German regions for most patients. Furthermore, we find that both demographics and other patient characteristics substantially contribute to regional variation and that causes of regional variation vary when comparing different regions within Germany.     

A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications

I look at three debates in the health economics literature in the context of cost-effectiveness analysis (CEA): 1) inclusion of future costs, 2) discounting, and 3) consistency with a welfare-economic perspective. These debates thus far have been studied in isolation leading to confusion and lingering questions. I look at these three debates holistically and present a welfare theoretic model that is consistent with the practice of CEA and can help inform all of these three debates. It shows rationales for the recommendations of the Second Panel and clarifies some nuanced implications for the practice of CEA when taking a societal perspective in the context of distributional CEA and multi-sectorial budgets.     

Transparency about internal audit results to reduce the supervisory burden: A qualitative study on the preconditions of sharing audit results

Many working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions. We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate.The interviewees expressed that there is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals.In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.     

Informal out-of-pocket payments for healthcare services in Greece

BackgroundInformal out-of-pocket (OOP) payments for healthcare services are not unusual in Greece.AimThis study estimates the association between respondent and incident-level characteristics and informal payments.MethodsA survey of 4218 households was conducted from November 2016 to February 2017. We analyzed healthcare incidents by all household members within the past four months. Multivariate negative binomial regression analysis was used to estimate the association between respondents and incident-level characteristics and informal OOP payments to providers.ResultsA total of 3494 healthcare incidents were reported by 3183 household-representatives. More-than-half (63 %) of all incidents involved informal activity (median=€150). About 30 % of those were related to provider requested payments. Using hospital, dental, diagnostic/screening, and emergency department services compared to primary care services and having oncological and surgical conditions were among the strongest predictors of higher rates for informal payments. The use of specific providers for reasons related to trust, reputation, referral, and lack of alternatives was also associated with higher rates of informal payments. Provider requested and skip the line payments were associated with larger OOP amounts compared to gratitude payments.ConclusionThis survey reveals that informal payments occur for higher-need and less cost-responsive healthcare services particularly in areas where patients lack alternatives. Health policy and regulatory interventions, including stricter control of the financial reporting system are essential to limit informal payments.     

Barriers to healthcare workers reporting adverse events following immunization in four regions of Ghana

Despite didactic training on adverse events following immunization (AEFI) in Ghana, the reporting ratio of AEFI was 1.56 per 100,000 surviving infants in 2015, below the minimum reporting ratio of 10. We aimed to estimate the proportion of health care workers (HCWs) reporting AEFI and to identify barriers to reporting.We conducted a cross-sectional survey of HCWs in four regions in Ghana. A simple random sample of 176 health facilities was selected and up to two HCWs were randomly selected per facility. We used the Rao-Scott Chi-squared test to compare factors associated with reporting of AEFI in the last year. We used an open-ended question to identify reasons for low reporting. One supervisor from each facility, responsible for overall reporting and management of AEFI, was also interviewed.A total of 306 HCWs from 169 facilities were interviewed. Of these, 176 (57.5%) reported they had ever encountered an AEFI. Of the 120 who had encountered an AEFI in the last year, 66 (55.0%) indicated they had reported the AEFI, and 38 (31.7%) completed a reporting form. HCWs (n = 120) reported multiple barriers to reporting of AEFI; the most common barriers were fear of personal consequences (44.1%), lack of knowledge or training (25.2%), and not believing an AEFI was serious enough to report (22.2%). Discussion of AEFI during the last supervisory visit was significantly associated with reporting in the past year (OR 7.39; p < .001). Of 172 supervisors interviewed, 65 (37.8%) mentioned their facilties had ever encountered an AEFI; over 90% of facilities had reporting forms.We identified low reporting of AEFI and multiple barriers to reporting among HCWs in the four selected regions of Ghana. Discussing AEFI during supervisory visits with HCWs might improve reporting. Additionally, strategies to address fear of personal consequences as a barrier to reporting of AEFI are needed.     

Attitudes towards varicella vaccination in parents and paediatric healthcare providers in Hungary

BackgroundVaricella vaccination is important in prevention of childhood infection. Aim of this cross-sectional study was to survey attitudes and determinants of support or refusal of varicella vaccination in parents and in paediatric healthcare professionals, mainly health visitors in Hungary prior to the introduction of this vaccine in National Immunization Program in 2019.MethodsBetween October 2018 and February 2019, 1042 parents and 198 healthcare professionals completed a self-administered anonymous questionnaire regarding sociodemographic background, knowledge and attitudes towards varicella vaccination, and reasons for non-vaccination.ResultsFrom the participating parents 53.3% have vaccinated at least one of their children. Vaccination rate was significantly higher in families with <3 children, living in the capital, among those who have seen complications of varicella and among parents with university degree. Most important positive determinant was recommendation of the vaccine by healthcare professionals: 77.8% of parents accepted vaccination when recommended by the paediatrician, despite the cost of the vaccine, whereas only 17.3% of parents vaccinated their children when the vaccine was not recommended by paediatrician. Most important reasons for non-vaccination was finding the vaccine unnecessary, concerns regarding side effects, and not believing in the vaccine’s effectiveness. Among paediatric healthcare professionals, support rate of universal varicella vaccination was 76.3%. Support rate was higher among those who have seen complications of varicella more often and those who consider varicella a severe infection. Reasons of professionals who do not support universal varicella vaccination were similar to those of vaccine hesitant parents. Practice of intentional exposure of non-immune child to infected ones still exist.ConclusionsEducational programs are needed for parents and health visitors to address concerns regarding vaccination. Paediatricians are the most trusted source of information for parents hence they have a significant responsibility and parents likely follow their recommendations.     

Organisational factors affecting performance in delivering influenza vaccination to staff in NHS Acute Hospital Trusts in England: A qualitative study

Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following “best practices”. It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.     

The continuum of influenza vaccine hesitancy among nursing professionals in Hong Kong

IntroductionInfluenza vaccine hesitancy among healthcare workers poses challenges to the achievement of herd immunity and causes infection risks to vulnerable patients. This study aimed to quantify the extent of influenza vaccine hesitancy among nurses in Hong Kong, to delineate its pattern, and to explore its socio-demographic, professional and personal correlates.MethodNurses in Hong Kong were recruited in a cross-sectional study involving the administration of an online questionnaire survey after the 2017/18 winter influenza season. Respondents’ influenza vaccination behaviours, attitudes and psychological antecedents were assessed, followed by their delineation into subgroups along the hesitancy continuum through a combination of multiple correspondence analysis and K-means cluster analysis. Socio-demographic, professional and personal correlations of subgrouping were investigated using generalised ordered logistic regression.ResultsThe overall vaccination coverage of nurses for the 2017/18 influenza season was 44%. Five clusters were differentiated by the level of influenza vaccine hesitancy: “Very high hesitancy-to-complete refusal” (n = 56; 7%) characterised by outright refusal of vaccination; “High hesitancy” (n = 171; 23%) distinguished by tendency of skipping vaccination and scepticism about safety of vaccine; “Moderate hesitancy” (n = 273; 36%) with uncertainties towards vaccination, mistrust of the government’s vaccine recommendations and priority concern on affordability of vaccine; “Low hesitancy” (n = 95; 13%) with cautious acceptance towards vaccination and “No-to-minimal hesitancy” (n = 158; 21%) with strong vaccine confidence and compliance greatly linked to convenience of vaccine access. Nurses having completed at least 3 years’ pre-registration professional training, having most family members vaccinated against influenza, and with influenza vaccination history during studentship were less vaccine hesitant.ConclusionWith more than half of the nurses in Hong Kong having moderate or higher level of influenza vaccine hesitancy, interventions customised to the needs of nurses as reflected from the characteristics of clusters along the vaccine hesitancy continuum could form an important strategy for improving vaccination uptake.