Intention of Delivering Home-based Healthcare Services and Influencing Factors in Community Healthcare Workers

doi:10.12114/j.issn.1007-9572.2019.00.090

Abstract

Abstract: Background　Some healthcare workers are not willing to deliver home-based healthcare services，due to medical risks and disputes easily occur during the process，and inappropriate staffing，leading to insufficient supply of such services to meet the demand.Objective　To investigate the intention of delivering home-based healthcare services and influencing factors in community healthcare workers，to provide suggestions for the sound development of such services.Methods　From January to February 2018，we conducted a survey in healthcare workers from 30 government-run community health organizations in A District of Beijing.We used a questionnaire in the survey developed by our research group on the basis of review of related studies，which consisted of 4 parts（sociodemographic characteristics，institutional allocation of resources for delivering home-based services，intention of and concerned issues during delivering home-based services）．Binary Logistic regression analysis was used to analyze factors associated with the intention of healthcare workers to provide home-based healthcare services.Results　Overall，275 of the 300 healthcare workers returned responsive questionnaires，obtaining a response rate of 91.7%.The prevalence of intending to deliver home-based healthcare services was 66.5%（183/275）．Logistic regression analysis showed that gender，position，years of working levels of attentiveness in physician-patient disputes，subsidies for delivering home-based healthcare services，and performance evaluation were the factors significantly associated with healthcare workers' intention of providing home-based healthcare services （P<0.05）．Conclusion　The level of intention to provide home-based healthcare services is high in community healthcare workers，but it needs to be improved.In view of this，we put forward the following suggestions：rationally allocating medical resources；increasing the supply of home-based healthcare services；improving the legal protection system，enhancing the healthcare workers' awareness of legal protection，and avoiding the occurrence of physician-patient disputes；improving the incentive and assessment mechanisms for home-based healthcare services.

Key words: Community health workers, Community health services, Home care services, Intension, Root cause analysis

摘要： 背景　上门医疗服务的过程中易发生医疗风险、医患纠纷、人员配置不足等问题，致使医务人员不愿意主动提供上门医疗服务，最终导致社区上门医疗服务供给量不足。目的　了解社区医务人员上门医疗服务的意愿及影响因素，为上门医疗服务顺利开展提供对策和建议。方法　2018年1—2月对北京市A区30家政府办社区卫生服务机构的医务人员进行问卷调查，采用文献研究法收集上门医疗服务相关文献设计问卷，内容包括社会人口学特征、机构出诊资源配置状况、出诊关注的问题及是否愿意提供上门医疗服务。采用二分类Logistic回归分析影响医务人员上门医疗服务意愿的影响因素。结果　总计发放问卷300份，回收有效问卷275份，有效回收率为91.7%。社区医务人员提供上门医疗服务的意愿率为66.5%（183/275）。Logistic回归分析结果显示，性别、岗位、工作年限、是否关注医患纠纷、是否关注出诊补助和绩效评定是医务人员有无上门医疗服务意愿的影响因素（P<0.05）。结论　医务人员有意愿提供上门医疗服务，但意愿仍有待提高。合理配置医疗资源，增加社区上门医疗服务供给量；健全法律保障制度，增强医务人员法律保护意识，避免医患纠纷的发生；完善上门医疗服务激励机制和考核机制，有助于提高社区医务人员的上门医疗服务意愿。

关键词: 社区卫生工作者, 社区卫生服务, 家庭医疗保健服务, 意愿, 影响因素分析

SONG Shuang,WU Xin,HU Lingjuan, et al. Intention of Delivering Home-based Healthcare Services and Influencing Factors in Community Healthcare Workers　[J]. Chinese General Practice, 2019, 22(10): 1229-1234. DOI: 10.12114/j.issn.1007-9572.2019.00.090.
宋爽,吴欣,胡凌娟等. 社区医务人员上门医疗服务意愿及影响因素研究[J]. 中国全科医学, 2019, 22(10): 1229-1234. DOI: 10.12114/j.issn.1007-9572.2019.00.090.

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