Evaluation of Home Health Services by General Practitioners in Beijing：a Qualitative Study

doi:10.12114/j.issn.1007-9572.2018.00.115

Abstract

Abstract:
Objective　To investigate the current situation and existing problems of home health services in Beijing，so as to provide suggestions for the sustainable development of home health services.Methods　During the period between January and February，2017，a total of 12 community health service institutions were selected from 6 urban districts of Beijing，of an institution from each of Dongcheng，Xicheng and Shijingshan districts，and 3 institutions from each of Haidian，Chaoyang and Fengtai districts，and 10 institutions were selected from suburban districts of Beijing by purposive sampling，of 4 institutions from Changping district，and 2 institutions from each of Tongzhou，Shunyi and Fangshan districts.A general practitioner was sampled from each of these 22 community health service institutions，and the general practitioners were divided into the urban group（n=12）and suburban group（n=10）for interviews.Focus-group interviews were done for data collection，and content analyses were performed for data management.Results　Home health services included family hospital beds，home nursing，home visits，and home health consultation.As the main body of home health services，general practitioners' service levels and professional capability directly affected the quality of home health services.Because of the high demand of home nursing，community nurses had the greatest workload in all home health services.Following analyses of the focus-group interview data，five themes were extracted，including（1）home health services could meet the urgent needs of home medical and nursing services for the elderly，notably the disabled elderly；（2）home health services have potential medical disputes and risks；（3）home health services lack perfect laws and operational guidelines；（4）healthcare workers have insufficient enthusiasms for home health services；and（5）currently，the ability of home health services is limited，and the service level varies between the urban and suburban regions.Conclusion　Home health services in Beijing meet the demand of health services for the disabled elderly；however，it is necessary to gradually improve the supporting management system and the guarantee mechanism，so as to further promote home health services.

Key words: Delivery of health care；General practitioners；Health care quality, access, and evaluation；Qualitative research

摘要： 目的　了解北京市上门医疗服务的开展现状和存在的问题，为上门医疗服务的可持续发展提供建议。方法　2017年1—2月，采用目的抽样法，在北京市6个城区中抽取12家社区卫生服务机构（其中在东城、西城、石景山区各抽取1家，在海淀、朝阳、丰台区各抽取3家），在4个郊区中抽取10家社区卫生服务机构（其中在昌平区抽取4家，在通州、顺义、房山区各抽取2家）。从以上22家社区卫生服务机构中各抽取1名全科医生为研究对象，将其分为市区组（12名）和郊区组（10名）分别进行访谈。采用专题小组访谈法进行资料收集，采用内容分析法对资料进行整理和分析。结果　上门医疗服务在家庭病床、家庭护理、家庭访视和家庭健康咨询4个方面均有涉及。作为上门医疗服务的主体，全科医生的服务水平和业务能力直接影响上门医疗服务质量；因居民对家庭护理需求量大，上门医疗服务中社区护士工作量最大。对访谈资料进行整理分析后，共提炼出5个主题：（1）上门医疗服务能够满足老年人尤其是失能老年人对居家医疗与护理的迫切需求；（2）上门医疗服务存在潜在的医患纠纷和医疗风险；（3）上门医疗服务缺乏完善的法律法规和操作规范；（4）医护人员上门医疗服务的积极性不高；（5）目前上门医疗服务能力有限，服务水平城乡之间存在差别。结论　北京市上门医疗服务满足了失能老年人的卫生服务需求，但需要在实践过程中逐步完善配套管理体系和保障机制，进一步提升上门医疗服务能力。

关键词: 卫生保健提供, 全科医生, 卫生保健质量, 获取和评价, 定性研究

ZHAO Chunyan,LIU Yingjie,SHAO Shuang, et al. Evaluation of Home Health Services by General Practitioners in Beijing：a Qualitative Study[J]. Chinese General Practice, 2018, 21(28): 3453-3458. DOI: 10.12114/j.issn.1007-9572.2018.00.115.
赵春艳,刘英杰,邵爽等. 北京市全科医生对上门医疗服务评价的质性研究[J]. 中国全科医学, 2018, 21(28): 3453-3458. DOI: 10.12114/j.issn.1007-9572.2018.00.115.

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