摘要
目的了解慢性病长处方政策对签约患者医疗质量的短期影响,探讨该政策的优势与不足,并提出可行建议。方法于2016年2月,选取枫林街道社区与家庭医生签约的患高血压/糖尿病的501例参保慢性病患者为干预组。采用方便抽样法,选取年龄、性别相匹配的500例相同条件患者按1∶1比例纳入对照组。干预组按照慢性病长处方政策执行,单次足量足品种配药,即单次处方1~2个月用量;对照组按照常规门诊处方政策执行,即单次处方两周用量。干预6个月后,采用自行设计的调查问卷进行调查。调查问卷的主要内容包括高血压/糖尿病并发症情况、因高血压/糖尿病或并发症至二三级医院就诊的次数、因高血压/糖尿病或并发症至医院住院的次数等。共发放问卷1 001份,回收有效问卷1 001份,问卷的有效回收率为100.0%。采用方便抽样法,选取某全科医生服务团队某日前来就诊的前8例签约患者和7例社区医务人员进行焦点小组访谈,了解其对慢性病长处方政策的反馈情况。结果干预期间,两组高血压/糖尿病新发并发症情况、因高血压/糖尿病或并发症至二三级医院就诊次数、因高血压/糖尿病或并发症住院次数比较,差异均无统计学意义(P>0.05)。干预6个月后,接受访谈的8例签约患者和7例社区医务人员均认为政策对医疗质量无影响,政策的优势在于给患者带来了便利和实惠,不足之处在于该政策覆盖慢性病病种较少、缺少激励机制以及实际实施过程中存在一定限制。结论慢性病长处方政策对签约患者医疗质量短期内无影响。建议该政策进一步调整优化,覆盖更多病种、增加政策激励细则及操作的便利性,成为构建合理分级诊疗秩序又一有益尝试。
Objective To observe the short - term effect of chronic disease patients with long - term prescription policy on the heahhcare quality of contracted patients and further analyze the advantages and disadvantage of this policy in order to provide policy makers with policy recommendations. Methods In February 2016, 501 patients with hypertension/diabetes who contracted with family doctors were enrolled from the Fenglin Community Health Service Center of Xuhui District as the intervention group. Using the convenience sampling approach, another 500 patients with similar disease were recruited by family doctors as the control group according to the age and gender in a 1：1 ratio. According to the chronic disease patients with long - term prescription policy, the intervention group was prescribed enough quantities and varieties of medicine at a time, that was the medicine should be enough to he taken for one to two months. The control group was prescribed according to the routine prescription policy, that was the amount of the single prescription should be enough for two weeks. After six months of intervention, a self- designed questionnaire was used to investigate hypertension/diabetes complications, the times of clinical visits to secondary class or top class hospitals due to hypertension/diabetes and its complications, the times of hospitalizations due to hypertension/diabetes and its complications and so on. A total of 1 001 questionnaires were distributed and all 1001 questionnaires were retrieved. The effective recovery rate was 100. 0%. Using the convenience sampling approach, the first eight patients who visited the family doctors in one day and seven community medical staff were selected to be interviewed as a focus group to collect their feedback on the chronic disease patients with long - term prescription policy. Results During the intervention, there were no significant differences for both groups in the times of new occurring complication, the times of clinical visits to secondary class or top class hospi
出处
《中国全科医学》
CAS
北大核心
2017年第25期3084-3087,共4页
Chinese General Practice
基金
上海市卫生和计划生育委员会卫生计生政策研究课题(2016HP027)
关键词
慢性病
药物处方
医疗质量
社区卫生服务
Chronic disease
Drug prescriptions
Healthcare quality
Community health services
