Abstract: Objective　To study the development status of traditional Chinese medicine in primary health care institutions,and to analyze the existing problems of traditional Chinese medicine service in community health service centers so as to provide policy suggestions for developing traditional Chinese medicine service in community health service centers thoroughly and effectively.Methods　From October to December in 2015,according to the division results of China-Eastern region,Central region and Western region,two provinces/municipalities （Zhejiang,Beijing）,a province （Anhui）,two provinces（Sichuan,Guizhou） were randomly selected from Eastern region,Central region and Western region respectively,and then two community health service centers were randomly selected from each province/municipality as the study unit.The basic situation of service population,equipment situation of traditional Chinese medicine resources,developing situation of traditional Chinese medicine service in community health service centers were investigated.By convenience sampling method,300 residents in areas under administration of 10 community health service centers were investigated.The survey included satisfaction of residents of traditional Chinese medicine service in the local community health service centers.Results　The registered population under the jurisdiction of 10 community health service centers was 769 810,the permanent population was 920 548,including 128 881 permanent aged people and 34 954 children aged 0 to 3.The 10 community health service centers had all set up and constructed the department of traditional Chinese medicine in accordance with the requirements.In the 10 community health service centers,the total number of practitioners was 472,and the number of traditional Chinese medicine practitioners was 158 （accounted for 33.47%）;the highest rate that the number of traditional Chinese medicine practitioners in the total number of practitioners was 55.56% （5/9）,and the lowest rate was 11.11% （4/36）.In the community health service centers of Eastern regions,Central regions and Western regions,the average rate of the number of traditional Chinese medicine practitioners in the total number of practitioners was 34.00% （85/250）,34.00% （17/50）,and 32.56% （56/172） respectively.The average kinds of the 10 community health service centers equipping with traditional Chinese medicine decoction pieces were 389.The average types of the community health service centers in Eastern regions,Central regions and Western regions equipping with traditional Chinese medicine decoction pieces were 435,373 and 351 respectively.The 10 community health service centers were equipped with traditional Chinese medicine service and traditional Chinese medicine appropriate technology.The outpatient quantity of 10 community health service centers in 2014 was 1 088 929,the outpatient quantity of traditional Chinese medicine was 369 976 （33.98%）;among the 10 community health service centers,the highest rate of the outpatient quantity of traditional Chinese medicine in the total outpatient quantity was 51.30% （41 000/79 922）,and the lowest rate was 12.00% （4 750/39 583）.The average rate of the outpatient quantity of traditional Chinese medicine in the total outpatient quantity of community health service centers in Eastern regions,Central regions and Western regions was 33.15% （284 794/859 210）,29.75% （37 066/124 588）,and 45.77% （48 116/105 131） respectively.In the 5 d outpatient prescriptions in December 2014 of the 10 community health service centers， the total number of outpatient prescriptions was 10 716,of which the number of traditional Chinese medicine prescriptions was 4 306 （40.18%）;in the 10 community health service centers,the highest rate of traditional Chinese medicine prescriptions in the total number of outpatient prescriptions was 55.11% （392/675）,and the lowest rate was 15.17% （22/145）.In the community health service centers of Eastern regions,Central regions and Western regions,the average rate of traditional Chinese medicine prescriptions in total outpatient prescriptions was 37.09% （2 469/6 657）,32.39% （501/1 547）,and 53.18% （1 336/2 512） respectively.The total income of community health service centers in 2014 of the 10 community health service centers was 286.85 million yuan,of which the total income of traditional Chinese medicine diagnosis and treatment was 64.547 million yuan （22.50%）;in the 10 community health service centers,the highest rate of income of traditional Chinese medicine diagnosis and treatment in the total income of diagnosis and treatment was 57.17% （11.079 3 million/19.38 million）,and the lowest rate was 6.34% （1.02 million/16.09 million）.In the community health service centers of Eastern regions,Central regions and Western regions,the average rate of the income of traditional Chinese medicine diagnosis and treatment in the total income of diagnosis and treatment of was 28.40% （48.494 6 million/170.73 million）,26.48% （1.692 million/6.39 million）,and 13.09% （14.360 4 million/109.73 million） respectively.The average types of appropriate technologies developing by the 10 community health service centers were 9.8 community health service centers （4 in the Eastern region,2 in the Central region and 2 in the Western region） carried out health management services of traditional Chinese medicine of pregnant and lying-in woman,9 community health service centers （4 in the Eastern region,2 in the Central region and 3 in the Western region） carried out health management services of traditional Chinese medicine of hypertension and diabetes patients.The 10 community health service centers had all developed the recognition service of TCM constitution for the elderly and carried out traditional Chinese medicine nursing services for children.There were 264 effective questionnaires among the 300 questionnaires with an effective response rate of 88.0%.85.98% of residents believed that it is convenient to see doctors of traditional Chinese medicine in community health service centers;74.24% were satisfied with the service price of traditional Chinese medicine in community health service centers;63.64% were satisfied with the reimbursement ratio of medical insurance in traditional Chinese medicine service;78.41% were satisfied with the technological level of traditional Chinese medicine;71.59% deemed that traditional Chinese medicine service provided by community health service centers can meet their basic needs.Conclusion　The 10 community health service centers have all set up and constructed the department of traditional Chinese medicine in accordance with the requirements,moreover they are equipped with traditional Chinese medicine service as well as appropriate technology of traditional Chinese medicine.The rate of practitioners of traditional Chinese medicine accounts for over 32.00% in the community health service centers across Eastern regions,Central regions and Western regions,the outpatient quantity of traditional Chinese medicine occupies over 29.00%,the rate of prescriptions of traditional Chinese medicine is over 32.00%,and the income of traditional Chinese medicine diagnosis and treatment was over 26.00%.The above data indicate that traditional Chinese medicine service in Chinese community health service centers is gradually perfected and its functions is gradually improved,however,there is still problems of regional development imbalance in Eastern regions,Central regions and Western regions,and the ratio of residents satisfied with traditional Chinese medicine service in community health service centers needs improving.

Key words: Institution of traditional Chinese medicine, Community health services, Satisfaction situation of patients

摘要： 目的　了解目前我国中医药服务在基层医疗卫生机构中的开展现状，分析社区卫生服务中心中医药服务存在的问题，为深入、有效开展社区卫生服务中心中医药服务提出政策建议。方法　2015年10—12月，按照我国东、中、西部地区的区域划分结果，采用目的抽样法在东、中、西部地区分别随机抽取2个省/直辖市（浙江省、北京市）、1个省（安徽省）、2个省（四川省、贵州省），然后在每个省/直辖市随机选取2家社区卫生服务中心作为调查单元。调查社区卫生服务中心服务人口基本情况、社区卫生服务中心中医资源配备情况、社区卫生服务中心中医药服务开展情况。采用方便抽样法抽取10家社区卫生服务中心辖区居民300人进行调查，调查内容包括居民对所在社区卫生服务中心中医药服务的满意度情况。结果　10家社区卫生服务中心辖区的户籍人口为769 810人，常住人口920 548人，其中常住老年人128 881人，0~3岁儿童34 954人。10家社区卫生服务中心均按照要求进行了中医科室的设置和建设。10家社区卫生服务中心中，执业医师总数为472人，中医执业医师为158人（33.47%）；中医执业医师数占执业医师数总数最高比率为55.56%（5/9），最低比率为11.11%（4/36）。东部、中部、西部地区社区卫生服务中心的中医执业医师数占执业医师总数的34.00%（85/250）、34.00%（17/50）、32.56%（56/172）。10家社区卫生服务中心平均配备中药饮片种类为389种。东部、中部、西部地区社区卫生服务中心平均配备的中药饮片种类分别为435、373、351种。10家社区卫生服务中心均配备中医药服务和中医药适宜技术。10家社区卫生服务中心2014年度门诊量为1 088 929人次，中医门诊量为369 976人次（33.98%）；10家社区卫生服务中心中，中医门诊量占门诊总量最高比率为51.30%（41 000/79 922），最低比率为12.00%（4 750/39 583）。东部、中部、西部地区社区卫生服务中心的中医门诊量占门诊总量的33.15%（284 794/859 210）、29.75%（37 066/124 588）、45.77%（48 116/105 131）。10家社区卫生服务中心2014年度12月份5 d门诊处方中，门诊处方总数为10 716张，其中中医药处方数为4 306张（40.18%）；10家社区卫生服务中心中，中医药处方量占门诊处方总量最高比率为55.11%（392/675），最低比率为15.17%（22/145）。东部、中部、西部地区社区卫生服务中心的中医药处方量占门诊处方总量的37.09%（2 469/6 657）、32.39%（501/1 547）、53.18%（1 336/2 512）。10家社区卫生服务中心2014年度社区卫生服务中心诊疗总收入28 685万元，其中中医药诊疗总收入6 454.70万元（22.50%）；10家社区卫生服务中心中，中医药诊疗收入占诊疗总收入最高比率为57.17%（1 107.93万/1 938万），最低比率为6.34%（102.00万/1 609万）。东部、中部、西部地区社区卫生服务中心的中医药诊疗收入占诊疗总收入的28.40%（4849.46万/17 073万）、26.48%（169.20万/639万）、13.09%（1 436.04万/10 973万）。10家社区卫生服务中心平均开展的中医药适宜技术种类为9种。8家（东部地区4家，中部、西部地区各2家）社区卫生服务中心开展了孕产妇的中医药健康管理服务，9家（东部地区4家、中部地区2家、西部地区3家）社区卫生服务中心开展了高血压患者和糖尿病患者的中医药健康管理服务。10家社区卫生服务中心均开展了老年人体质辨识服务和儿童中医药调养服务。300份调查问卷中有效调查问卷264份，有效调查率为88.0%。85.98%的居民认为到社区卫生服务中心看中医较为方便；74.24%的居民对社区卫生服务中心的中医药服务价格满意；63.64%的居民对医保在中医药服务方面的报销比例满意；78.41%的居民对社区卫生服务中心的中医技术水平满意；71.59%的居民认为社区卫生服务中心提供的中医药服务能满足其基本需求。结论　10家社区卫生服务中心均按照要求进行了中医科室的设置和建设，且均配备中国医药服务及中医药适宜技术，东部、中部、西部地区社区卫生服务中心的中医执业医师所占比率均在32.00%以上，中医门诊量所占比率均在29.00%以上，中医药处方量所占比率均在32.00%以上，中医药诊疗收入所占比率均在26.00%以上，说明我国社区卫生服务中心中医药服务网络正在逐步健全、功能正在逐渐完善，但目前仍存在东部、中部、西部地区发展不平衡等问题，且居民对社区卫生服务中心中医药服务满意比例仍有待提高。

关键词: 中医药机构, 社区卫生服务, 病人满意情况