Workload of Public Health Services in Primary Medical and Health Institutions: a Seven-year Trend Analysis

doi:10.12114/j.issn.1007-9572.2020.00.480

Abstract

Abstract: Background　In the assessment of the performance of public health services in primary care recently，increasing attentions have been paid to quality-related dimensions of the services，but the volume of such services is also worthy of great concern. Objective　To explore the changes in volume and category composition of public health services delivered by primary care and associated reasons. Methods　Data were collected from a community health center in Shanghai，including monthly workload and categories of public services，and public health team task load during January 2010 to December 2016. Composition analysis，trend description and Joinpoint regressions were used to describe temporal changes in workload. Results　During the study period，the total public health service workload of the community health service center was 58 937.83 person days. The highest monthly workload was 1 020.79 person days in December 2016 and the lowest was 461.56 person days in January 2012. Results from Joinpoint analysis showed that on average monthly workload declined by 4.1% before February 2011，and since then changed to a monthly increase of 0.6%（P<0.05）. The top-ranked four categories in terms of workload had always been chronic disease prevention and treatment，maternal and child health care，vaccination services，and government's practical projects，the combined composition ratio of which rose from 71.97% in 2010 to 79.84% in 2016. The median monthly workload of public health staff was higher than the legal standard of 20.83 days except for December 2010 and January 2012. And there were 6，5，9 months in 2010，2015，and 2016，respectively with a median workload above 30 days. Conclusion　Monthly workload of public health services for this community health center steadily increased since 2011，composition of key tasks continuously increased，in particular for prevention and treatment of chronic diseases，and workload of public health staff has been high. Workload varies with higher requirements，changes of population needs，and major public health programs or key projects in a specific phase.Future plans should focus more on the balance between essential public health services and major public health projects，impacts of heavy workload of public health staff，and treatment and prevention integration in order to improve the efficiency of services.

Key words: Community health services, Public health, Workload, Joinpoint regression

摘要： 背景　近年来对基层医疗卫生机构公共卫生服务的考核不断提质扩面，基层医疗卫生机构公共卫生服务的工作负荷值得关注。目的　分析基层医疗卫生机构公共卫生服务工作量及类别构成的变化趋势，分析变化的原因。方法　以上海市某社区卫生服务中心为研究对象，收集2010年1月—2016年12月的月度公共卫生服务工作量、服务类别及人员分工等信息，采用构成比分析、趋势描述与Joinpoint回归刻画工作量的时间变化。结果　研究时段内该社区卫生服务中心的公共卫生服务工作量合计58 937.83人天，月度工作量最高值为2016年12月的1 020.79人天，最低值为2012年1月的461.56人天。Joinpoint回归结果显示，2011年2月前中心公共卫生服务工作量每月平均下降4.1%（P<0.05），后转为每月上升0.6%（P<0.05）。慢性病防治、妇幼保健、计划免疫、政府实事项目四类服务始终位于各年度工作量前4位，合计的构成比由2010年的71.97%上升至2016年的79.84%。研究时段内中心公共卫生人员的月度工作量中位值除2010年12月、2012年1月以外均高于法定值20.83 d，在2010、2015、2016年分别有6、5、9个月的月度工作量中位值高于30 d。结论　基层医疗卫生机构公共卫生服务量自2011年平稳上升，重点工作构成持续增加，尤其慢性病防治明显提升，公共卫生人员人均负荷持续在高位运行。工作量随工作要求提高、人群需求变化、重大项目或阶段性重点工作而变化。未来规划应注重基本公共卫生服务与重大公共卫生服务项目的平衡，重视公共卫生人员高工作负荷的影响，强化“医防融合”以提升服务效率。

关键词: 社区卫生服务, 公共卫生, 工作量, Joinpoint回归

SHI Jianhua,GU Huining,QIAN Mengcen, et al. Workload of Public Health Services in Primary Medical and Health Institutions: a Seven-year Trend Analysis　[J]. Chinese General Practice, 2020, 23(34): 4291-4297. DOI: 10.12114/j.issn.1007-9572.2020.00.480.
施建华,顾慧宁,钱梦岑等. 基层医疗卫生机构公共卫生服务工作量趋势变化与分析[J]. 中国全科医学, 2020, 23(34): 4291-4297. DOI: 10.12114/j.issn.1007-9572.2020.00.480.

References

［1］李程跃，孙梅，郝模，等．推进我国基本公共卫生服务均等化的策略思路［J］．中国卫生资源，2015，18（1）：10-12．DOI：10.13688/j.cnki.chr.2015.14173.
LI C Y，SUN M，HAO M，et al．Strategies to promote the equalization of basic public health services in China［J］．Chinese Health Resources，2015，18（1）：10-12．DOI：10.13688/j.cnki.chr.2015.14173.
［2］付晨．上海新一轮社区卫生综合改革的问题导向与核心举措［J］．中国卫生资源，2015，18（5）：309-311．DOI：10.13688/j.cnki.chr.2015.15219.
FU C．Problem orientation and critical measure in new round community health comprehensive reform of Shanghai［J］．Chinese Health Resources，2015，18（5）：309-311．DOI：10.13688/j.cnki.chr.2015.15219.
［3］秦江梅．国家基本公共卫生服务项目进展［J］．中国公共卫生，2017，33（9）：1289-1297．DOI：10.11847/zgggws2017-33-09-01.
QIN J M．Progress in basic public health service projects in China［J］．Chinese Journal of Public Health，2017，33（9）：1289-1297．DOI：10.11847/zgggws2017-33-09-01.
［4］李妍婷，李明，黄煊，等．浦东新区社区卫生服务机构工作效率与职工薪酬分析［J］．中国初级卫生保健，2015，29（11）：7-9．DOI：10.3969/j.issn.1001-568X.2015.11.0003.
LI Y T，LI M，HUANG X，et al．Analysis on work efficiency and salary status of community health service institutions in Pudong New Area［J］．Chinese Primary Health Care，2015，29（11）：7-9．DOI：10.3969/j.issn.1001-568X.2015.11.0003.
［5］李明，张宜民，张韬，等．上海市浦东新区社区医疗卫生服务效率与区域医疗协同性分析［J］．中华全科医师杂志，2019，18（7）：691-693．DOI：10.3760/cma.j.issn.1671-7368.2019.07.018.
LI M，ZHANG Y M，ZHANG T，et al．Efficiency and coordination of medical service in community health service centers of Shanghai Pudong New Area［J］．Chinese Journal of General Practitioners，2019，18（7）：691-693．DOI：10.3760/cma.j.issn.1671-7368.2019.07.018.
［6］李长春，滕莉，赵猛，等．天津市滨海新区塘沽社区卫生服务机构妇女保健服务的工作量分析［J］．中国卫生事业管理，2015，32（1）：15-17．
LI C C，TENG L，ZHAO M，et al．Analysis of women's health care service workload of community health service cnters in Tianjin Binhai New Area Tanggu［J］．Chinese Health Service Management，2015，32（1）：15-17．
［7］汤真清，王玲，钟姮，等．上海市社区卫生服务供需双方满意度调查［J］．中国卫生资源，2018，21（5）：441-445，451．DOI：10.3969/j.issn.1007-953X.2018.05.016.
TANG Z Q，WANG L，ZHONG H，et al．Investigation on satisfaction of the supply and demand of community health service in Shanghai［J］．Chinese Health Resources，2018，21（5）：441-445，451．DOI：10.3969/j.issn.1007-953X.2018.05.016.
［8］张明秋，刘德忠．成都市基层公共卫生人员工作满意度及影响因素分析［J］．卫生软科学，2016，30（10）：43-45，53．DOI：10.3969/j.issn.1003-2800.2016.10.012.
ZHANG M Q，LIU D Z．Research on job satisfaction and its influencing factors of primary public health workers in Chengdu［J］．Soft Science of Health，2016，30（10）：43-45，53．DOI：10.3969/j.issn.1003-2800.2016.10.012.
［9］原徐汇区卫生计生委．关于下发徐汇区社区卫生服务中心公共卫生标准化工作量实施方案的通知［EB/OL］．（ 2016-03-16）［2019-08-15］．http://www.xuhui.gov.cn/H/xhxxgk/xxgk_wsj_bmwj_bmwj/Info/Detail_16708.htm.
［10］劳动部调整月平均工作时间和工资折算办法［J］．职业，2008，15（4）：73．
［11］曹萌，汤真清，张天晔，等．上海市家庭医生制度（1.0版）建设进展分析［J］．中国卫生资源，2018，21（5）：433-436．DOI：10.3969/j.issn.1007-953X.2018.05.014.
CAO M，TANG Z Q，ZHANG T H，et al．Analysis on the progress of Shanghai family doctor system（version 1.0）［J］．Chinese Health Resources，2018，21（5）：433-436．DOI：10.3969/j.issn.1007-953X.2018.05.014.
［12］汤真清，李潇骁，钟姮，等．上海市基层医疗卫生服务现状分析［J］．中国卫生资源，2018，21（5）：428-432．DOI：10.3969/j.issn.1007-953X.2018.05.013.
TANG Z Q，LI X X，ZHONG H，et al．Current situation of primary health care service in Shanghai［J］．Chinese Health Resources，2018，21（5）：428-432．DOI：10.3969/j.issn.1007-953X.2018.05.013.
［13］上海市人民政府办公厅．上海市人民政府办公厅关于印发《上海市防治慢性非传染性疾病中长期规划（2018—2030年）》的通知［EB/OL］．（ 2018-08-28）［2019-08-15］．http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw56743.html.
［14］谢飞，何燕玲，谢斌，等．上海市精神卫生服务体系建设初探［J］．中华医院管理杂志，2019，35（2）：94-99．DOI：10.3760/cma.j.issn.1000-6672.2019.02.003.
XIE F，HE Y L，XIE B，et al．Approach to the mental health service system development in Shanghai［J］．Chinese Journal of Hospital Administration，2019，35（2）：94-99．DOI：10.3760/cma.j.issn.1000-6672.2019.02.003.
［15］上海市人民政府办公厅．上海市人民政府办公厅关于转发市卫生计生委等三部门制订的《上海市加强公共卫生体系建设三年行动计划（2015年—2017年）》的通知［EB /OL］．（2015-09-21）［2019-08-15］．http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw45010.html.
［16］汪曦，王烨，金宝芳，等．2011—2015年上海市闵行区第二类疫苗使用情况分析［J］．中国生物制品学杂志，2018，31（2）：166-169，176．
WANG X，WANG Y，JIN B F，et al．Analysis on application of vaccines of classⅡ in Minhang District，Shanghai City during 2011—2015［J］．Chinese Journal of Biologicals，2018，31（2）：166-169，176．
［17］虎磊，罗银波，汪瓒，等．湖北省城乡基层医务人员工作满意度研究［J］．中国初级卫生保健，2018，32（10）：12-14．DOI：10.3969/j.issn.1001-568X.2018.10.0005.
HU L，LUO Y B，WANG Z，et al．Research on job satisfaction of employees of urban and rural primary health institutions in Hubei Province［J］．Chinese Primary Health Care，2018，32（10）：12-14．DOI：10.3969/j.issn.1001-568X.2018.10.0005.
［18］于贞杰，李向云，刘田丽，等．基于象限分析的基层卫生人员基本公共卫生服务能力多维度评价［J］．中国卫生事业管理，2017，34（11）：866-869．
YU Z J，LI X Y，LIU T L，et al．Multidimensional evaluation of essential public health services capability of primary health staffsbased on quadrant analysis［J］．Chinese Health Service Management，2017，34（11）：866-869.
［19］蔡淳，周晓伟，姜综敏，等．夯实体系建设促进医防融合推进上海慢性病全程健康管理［J］．上海预防医学，2016，28（10）：682-686．
CAI C，ZHOU X W，JIANG Z M，et al．To improve health care management of non-communicable disease in all phases in Shanghai，through system establishment and integration of treatment and prevention［J］．Shanghai Journal of Preventive Medicine，2016，28（10）：682-686．

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