上海市社区卫生服务机构双休日门诊开设现状研究

背景　上海市于2011年下发通知对社区卫生服务机构开设双休日门诊提出要求，目前尚缺乏针对双休日门诊开设和利用情况的研究。目的　了解上海市社区卫生服务机构双休日门诊的开设现状，为相关部门制定政策提供参考依据。方法　于2018年8—9月，对上海市全部共282家社区卫生服务机构开展调查，包括243家社区卫生服务中心和39家分中心。由机构相应负责人根据机构在2018年1—6月开展双休日门诊情况填写问卷，主要内容包括双休日门诊的开设情况、门诊量、人力资源及加班补贴情况，所有问卷均有效回收。结果　上海市社区卫生服务机构的双休日门诊开设率为95.7%（270/282），其中周六上午的开设率最高〔95.0%（268/282）〕。上海市社区卫生服务机构双休日日均门诊量为81 980人次，社区卫生服务中心日均门诊量排在前3位的地区（青浦区448.50人次、闵行区445.75人次、浦东新区437.79人次）和社区卫生服务分中心日均门诊量排在前2位的地区（青浦区248.60人次、闵行区156.67人次）均处郊区，社区卫生服务中心的平均日均门诊量高于分中心（321.99人次比151.03人次）。仅在周六上午开设门诊的社区卫生服务机构的平均日均门诊量为307人次，其他时间段的门诊量较低。在开设了双休日门诊的社区卫生服务机构，30.4%（82/270）认为人力资源不能满足双休日开诊需要，15.2%（41/270）发放了双休日加班补贴。结论　上海市社区卫生服务机构周六上午的门诊开设率较高，且利用情况较好；双休日门诊利用情况，郊区优于城区，社区卫生服务中心优于分中心；社区卫生服务机构开设双休日门诊的人力资源不足。建议社区卫生服务服务机构合理分配双休日医疗资源，通过补充人员缓解双休日门诊的人力资源压力，并采取激励措施提高医务人员的双休日工作积极性。

The Weekend Outpatient Services Delivered by Community Healthcare Institutions in Shanghai

Background　Shanghai issued a notice in 2011 requiring community healthcare institutions to deliver weekend outpatient services.At present，there is a lack of research on the delivery and utilization of weekend outpatient services.Objective　 To investigate the implementation status of weekend outpatient services in community healthcare institutions in Shanghai，to provide a reference for relevant departments to formulate policies.Methods　This survey was conducted between August and September，2018.Managers from all（282） community healthcare institutions〔243 community health centers（CHCs） and 39 community health sub-centers〕 in Shanghai were invited to participate in the survey and to fill in a self-administered questionnaire on the implementation of weekend outpatient services in their own institution during January to June，2018，involving the prevalence of delivery，outpatient visits，workers，and overtime allowance.The survey achieved a response rate of 100.0%.Results　Among the community health institutions，95.7%（270/282） delivered outpatient services on weekend，of them those delivering such services on Saturday morning accounted for the largest proportion〔95.0%（268/282）〕 of the total.The average daily outpatient visits on weekend of community healthcare institutions in Shanghai were 81 980.The top three districts（448.50 in Qingpu District，445.75 in Minhang District，437.79 in Pudong New District） owing the most average daily outpatient visits on weekend of CHCs and top two districts（248.60 in Qingpu District，156.67 in Minhang District） owing the most average daily outpatient visits on weekend of community health sub-centers were suburbs.CHCs showed more average daily visits on weekend than community health sub-centers（321.99 vs. 151.03）.Community healthcare institutions delivering outpatient services only on Saturday morning had an average daily outpatient visits on weekend of 307，and lower average visits on other weekend hours.Of those delivering outpatient services on both Saturday and Sunday，30.4%（82/270） thought that the number of health workers could not satisfy the healthcare needs of patients；15.2%（41/270） paid weekend overtime allowances to health workers.Conclusion　Outpatient services delivered on Saturday morning can be found in most community healthcare institutions in Shanghai，and are well utilized.The services are better utilized in suburban districts than in urban districts，and in CHCs than in community health sub-centers.However，the number of health workers can't meet the healthcare needs of patients in those delivering such services on Saturday and Sunday.It is suggested that community healthcare institutions should allocate medical resources reasonably，increase the number of health workers to alleviate the pressure of weekend outpatient workloads，and take incentive measures to raise the workers' enthusiasm in offering such services.