【摘要】：1目的 通過(guò)對(duì)廣州市基層醫(yī)療機(jī)構(gòu)基本藥物制度實(shí)施情況，患者滿(mǎn)意度及醫(yī)務(wù)人員滿(mǎn)意度的調(diào)查，了解廣州市基層醫(yī)療機(jī)構(gòu)基本藥物制度的實(shí)施效果和現(xiàn)況。分析比較廣州市基本藥物制度實(shí)施中出現(xiàn)的問(wèn)題和取得的成就，為進(jìn)一步完善廣州市基本藥物制度和基本藥物目錄提供數(shù)據(jù)資料，評(píng)價(jià)結(jié)果和建議，供決策使用。 2方法 （1）文獻(xiàn)研究法：主要收集近幾年有關(guān)國(guó)內(nèi)外基本藥物和國(guó)家基本藥物制度的研究文獻(xiàn)，經(jīng)過(guò)相關(guān)的分析處理，撰寫(xiě)綜述以便供研究借鑒。 （2）基本藥物制度數(shù)據(jù)直報(bào)系統(tǒng)：通過(guò)廣州市衛(wèi)生信息中心基本藥物直報(bào)系統(tǒng)提取廣州市基層醫(yī)療機(jī)構(gòu)基本藥物配備使用、衛(wèi)生服務(wù)利用情況、業(yè)務(wù)收支情況。 （3）現(xiàn)況調(diào)查：采用典型抽樣選取廣州市145家政府辦的社區(qū)衛(wèi)生服務(wù)中心，同時(shí)每家選取10名醫(yī)務(wù)人員，采用調(diào)查表收集社區(qū)衛(wèi)生服務(wù)中心相關(guān)情況、醫(yī)務(wù)人員認(rèn)知及滿(mǎn)意度情況；采用典型抽樣抽取廣州市15家社區(qū)衛(wèi)生服務(wù)中心，每家基層醫(yī)療機(jī)構(gòu)由兩名調(diào)查員負(fù)責(zé)選取當(dāng)天上午的門(mén)診患者調(diào)查問(wèn)卷。 3結(jié)果 （1）廣州市基層醫(yī)療機(jī)構(gòu)門(mén)急診人次和出院人次2010年到2012年年平均增長(zhǎng)率分別為16.53%和24.87%，均呈逐年上升趨勢(shì)。廣州市2010年和2012人均門(mén)急診費(fèi)用分別為86.19元和85.56元，，人均門(mén)急診藥品費(fèi)用分別為50.01元和47.99元。 （2）廣州市門(mén)急診收入、住院收入和財(cái)政補(bǔ)償收入2010年到2012年年平均增長(zhǎng)率分別為23.40%、22.67%和22.33%。從2010年到2012年，門(mén)急診藥品收入占總收入的比例分別為58.35%，52.64%和52.95%，住院藥品收入占占總收入比例分別為37.37%，34.42%和33.48%，均呈下降趨勢(shì)。 （3）從基本藥物實(shí)際使用品種數(shù)上看，平均在550種左右，社區(qū)衛(wèi)生服務(wù)中心配備品種數(shù)最高，一般鎮(zhèn)衛(wèi)生院配備品種數(shù)最少。選取10個(gè)關(guān)于基層醫(yī)療機(jī)構(gòu)運(yùn)行效率的指標(biāo)，采用最優(yōu)距離法進(jìn)行綜合評(píng)價(jià)分析。社區(qū)衛(wèi)生服務(wù)中心2010年到2012年運(yùn)行效果呈向上趨勢(shì)。中心鎮(zhèn)衛(wèi)生院和一般鎮(zhèn)衛(wèi)生院均為2011年綜合指標(biāo)值最小，分別為0.0411和20.0255，說(shuō)明2011年實(shí)施效果最好，其次為2012年，2010年最差。 （4）醫(yī)務(wù)人員基本藥物知曉率總體偏高，24.5%的醫(yī)務(wù)人員非常熟悉，60.5%表示比較熟悉。醫(yī)務(wù)人員對(duì)基本藥物制度可以降低患者醫(yī)療費(fèi)用認(rèn)可度最高，但對(duì)基本藥物制度能增加患者滿(mǎn)意度最低。2.3%的醫(yī)務(wù)人員從未向患者宣傳過(guò)基本藥物知識(shí)，63.5%經(jīng)常向患者宣傳。 （5）患者知曉率總體偏低，僅55.1%的門(mén)診患者聽(tīng)說(shuō)過(guò)國(guó)家基本藥物制度，95.1%的患者愿意使用基本藥物，其中主要以聽(tīng)醫(yī)生為主，占42.5%。對(duì)醫(yī)務(wù)人員服務(wù)態(tài)度滿(mǎn)意度較高，但對(duì)藥品種類(lèi)滿(mǎn)意度最低。分類(lèi)樹(shù)結(jié)果顯示近半年來(lái)患者所花費(fèi)的總醫(yī)療費(fèi)用是影響門(mén)診患者滿(mǎn)意度的最重要因素，其次為職業(yè)。 4結(jié)論 （1）基本藥物制度對(duì)門(mén)急診業(yè)務(wù)影響不大，但對(duì)住院業(yè)務(wù)有所沖擊；基層醫(yī)療機(jī)構(gòu)甚至出現(xiàn)患者返流至大醫(yī)院的現(xiàn)象； （2）基層醫(yī)療機(jī)構(gòu)均配備使用基本藥物，但是國(guó)家基本藥物目錄品種偏少；基本藥物缺失情況嚴(yán)重，存在不配送和配送不及時(shí)問(wèn)題； （3）醫(yī)務(wù)人員對(duì)基本藥物制度認(rèn)可度一般，向患者宣傳的積極性不高；患者滿(mǎn)意度較高，對(duì)基本藥物種類(lèi)滿(mǎn)意度最低，同時(shí)認(rèn)知程度不高。
[Abstract]:1 purposes
Through the investigation of the basic drug system implementation of the basic medical institutions in Guangzhou, the satisfaction of patients and the satisfaction of medical staff, the effect and current situation of the basic medical system of the basic medical institutions in Guangzhou are understood. The problems and achievements in the implementation of the basic drug system in Guangzhou are analyzed and compared, and the further improvement of Guangzhou is made in order to further improve the Guangzhou medical institution. The city's essential medicines system and basic drug list provide data, evaluation results and recommendations for decision making.
2 method
(1) literature research method: mainly collect research literature about basic drugs and national basic drug system at home and abroad in recent years, through related analysis and processing, write a summary for reference.
(2) the basic drug system data direct reporting system: through the Guangzhou municipal health information center basic drug direct reporting system to extract basic medical institutions in Guangzhou basic medical institutions, the use of basic medicine, health service utilization, business revenue and expenditure.
(3) the status survey: the community health service center of 145 governments in Guangzhou was selected by typical sampling, and 10 medical personnel were selected from each family. The questionnaire was used to collect the related information of community health service centers, the cognition and satisfaction of medical staff, and 15 community health service centers in Guangzhou were selected by typical sampling. A total of two investigators were selected to select the morning outpatient questionnaire.
3 Results
(1) the average annual growth rate of emergency patients and discharged people in Guangzhou medical institutions from 2010 to 2012, respectively, was 16.53% and 24.87%, respectively, showing an increasing trend year by year. In 2010 and 2012 per capita emergency expenses in Guangzhou were 86.19 yuan and 85.56 yuan respectively, and the cost of per capita emergency medicine was 50.01 yuan and 47.99 yuan, respectively.
(2) the average annual growth rate of Guangzhou emergency income, hospitalization income and financial compensation income from 2010 to 2012 was 23.40%. 22.67% and 22.33%. from 2010 to 2012 were 58.35%, 52.64% and 52.95%, respectively. The income of hospitalized drugs accounted for 37.37%, 34.42% and 33.48%, respectively. There is a downward trend.
(3) from the actual use of the basic drugs, the average number is about 550 species, the number of the community health service centers is the highest, and the number of the general township health centers is the least. 10 indexes on the operation efficiency of the basic medical institutions are selected and the optimal distance method is used for comprehensive evaluation and analysis. The community health service center is from 2010 to 2012. The operation effect was upward trend. The central town health hospital and the general town health hospital were the least comprehensive index in 2011, which were 0.0411 and 20.0255 respectively, indicating the best effect in 2011, followed by 2012, and the worst in 2010.
(4) the basic drug awareness rate of medical staff is generally high, 24.5% of the medical staff are very familiar with 60.5%, and 60.5% are familiar with them. The medical staff can reduce the medical expenses of the patients with the basic drug system, but the medical staff who can increase the lowest satisfaction of the patients with the basic drug system have never publicised the basic drug knowledge to the patients. Knowledge, 63.5% often publicize to the patient.
(5) the awareness rate of the patients was generally low. Only 55.1% of the outpatients had heard of the national basic drug system, and 95.1% of the patients were willing to use basic drugs. The majority of the patients were mainly listening to doctors, which accounted for a high degree of satisfaction to the service attitude of the medical staff and the lowest degree of satisfaction to the drug types. The results of the classification tree showed the total cost of the patients in the past six months. Medical expenses are the most important factors affecting the satisfaction of outpatients, followed by occupation.
4 Conclusion
(1) the basic drug system has little impact on the emergency service, but it has some impact on the inpatient service; the basic medical institutions even have the phenomenon of the patients returning to the large hospital.
(2) basic medical institutions are equipped with basic drugs, but the national basic drug catalogues are small; the lack of basic drugs is serious, and the problem of untimely delivery and distribution is not timely.
(3) the medical staff have a general acceptance of the basic drug system, and the enthusiasm of the patients is not high; the patients' satisfaction is high, the degree of satisfaction of the basic drugs is the lowest, and the degree of cognition is not high.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R95

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