0~3岁儿童社区儿科门诊就诊需求研究

背景　儿童“看病难”是我国儿科医疗常见问题,但社区卫生服务中心目前主要承担社区儿童的预防接种和儿童保健方面工作,儿童常见病诊疗处于“去基层化”状态,社区卫生服务机构增设儿科门诊势在必行。目的　了解0~3岁儿童的社区儿科门诊就诊需求,探讨其开展过程中的尚存问题,从而为增设社区儿科门诊提供依据。方法　于2018年3-7月,采用简单随机抽样法在月坛社区卫生服务中心、三里河二区社区卫生服务站、木樨地社区卫生服务站抽取儿童保健科门诊就诊的0~3岁儿童280例。采用研究组自行设计的问卷对纳入儿童家长进行调查,主要内容为儿童的基本信息和对社区儿科门诊需求情况。结果　共回收有效问卷270份,问卷有效回收率为96.4%。94.4%（255/270）的儿童家长认为非常需要/需要社区开设儿科门诊;若社区开设儿科门诊,92.6%（250/270）的家长愿意带儿童来就诊。目前,儿童患病后,73.7%（199/270）的家长首选到三级医院（包括儿童专科医院）就诊,20.7%（56/270）的家长首选到社区卫生服务机构就诊;儿童家长选择到社区卫生服务机构就诊的原因排在前2位的分别为距离近、就诊方便（55.9%,151/270）,就诊患儿少、挂号容易（53.3%,144/270）。儿童家长认为社区儿科门诊尚需解决的问题排在前3位的分别为医生技术水平较低（77.4%,209/270）、药品不齐全（56.3%,152/270）、缺乏设备（55.9%,151/270）。61.5%（166/270）的儿童家长希望就诊时与医生交流的时间为6~10 min;81.8%（221/270）的家长认为儿童患病后应先到社区卫生服务机构就诊,根据病情由社区医生转诊至三级医院。结论　0~3岁儿童对社区儿科门诊的诊疗需求较大,多数家长愿意带儿童到社区卫生服务机构就诊,也支持分级诊疗的就诊模式,但社区卫生服务机构的整体环境、检查设备配置、医生诊疗水平、药物配备等制约了社区儿科诊疗,需要从国家、医院、社区卫生服务机构等不同层面解决。

Needs Assessment of Pediatric Outpatient Clinic in Community for Children Aged 0-3

Background　Lacking GPs and facilities in the communities lead to the difficulties for Children's medical treatment is a common problem in pediatric medicine in China.The community health center mainly undertakes the work of vaccination and child health care for children in the communities.The diagnosis and treatment of common diseases in children are in the state of "de-rooting".It is imperative to add pediatric clinics to community health centers.Objective　To investigate the needs of pediatric outpatient clinics for parents aged 0-3 in a community in Xicheng District of Beijing and explore the remaining problems in order to provide a basis for the establishment of pediatric outpatient clinics in the local communities.Methods　From March to July 2018,a simple random sampling method was used to select children aged 0 to 3 at Yuetan Community Health Center,Community Health Station of Sanlihe District 2,and Muxidi Community Health Station and 280 children were selected.The parents of selected children were surveyed using the questionnaire designed by the research team.The main contents were demographics information about children and their demand for community pediatric clinics.Results　A total of 270（96.4%） valid questionnaires were collected.And 94.4%（255/270） of the parents thought that it was necessary to open a pediatric outpatient clinic in the local community.If there was a pediatric outpatient clinic in the community,92.6%（250/270） of the parents were willing to bring the children to see a doctor.At present,73.7%（199/270） of the parents preferred to visit a tertiary hospital（including children's hospital）,and 20.7%（56/270） of the parents preferred to visit a community health center.The top two reasons why children's parents chose to visit the community health institutions were the close distance（55.9%,151/270） and fewer patients（53.3%,144/270）.The parents believed that the top three problems in the community pediatric outpatient clinic were the low level of GPs' skills（77.4%,209/270）,incomplete medicines（56.3%,152/270）,and lack of equipment（55.9%,151/270）.A total of 61.5%（166/270） of the parents hoped to communicate with the GPs for 6~10 min at the time of the visit;81.8%（221/270） of the parents thought that the children should go to the community health centers first when they felt ill,and GPs would decide whether to transfer them to a tertiary hospital according to their conditions.Conclusion　Children aged 0-3 have a great need for community pediatric outpatient clinics in their local communities.Most parents are willing to take children to visit GPs in community health centers and support the mode of hierarchical medical treatment.However,the overall environment of community health service organizations,equipment configuration,the level of diagnosis and treatment and drug supply restrict the community pediatric diagnosis and treatment,which needs to be improved from different levels such as the state,hospitals and community health institutions.