Page 106 - 2022-34-中国全科医学

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services. Objective To investigate the safety support of home care services in primary health care institutions and the willingness
of medical personnel to provide home care services，so as to provide a reference basis for further promoting the development of
home medical care services. Methods From August to October 2021，1 131 cases of medical personnel from 49 primary health
care institutions in five economic regions of Sichuan Province were selected by convenience sampling method. A self-designed
questionnaire was used to collect data in the form of an electronic questionnaire called "Questionnaire Star". The questionnaire
included general information of medical staff（8 items），experience of providing medical care at home（2 items），safety
support of medical staff by medical institutions（7 items），and willingness of medical staff to provide home care（1 item）.
The willingness of medical personnel to provide home medical care services was compared across different characteristics，and
binary Logistic regression was used to analyze the factors influencing medical personnel's willingness to provide home medical
care services. Results Of the 1 131 primary care medical personnel，692（61.18%）reported experiences with home medical
care services，193（17.06%）reported adverse events or safety events during the services，531（46.95%）reported that
their medical institutions had not assessed the safety risks of patients receiving home medical care services，199（17.60%）
reported that their institutions had assessed the safety risks of medical staff visiting the home，299（26.44%）reported that the
app location system was used in the process of home services，273（24.14%）reported that medical staff equipped with devices
such as alarms and delay warnings，807（71.35%）reported that they did not receive service support from other medical staff
within their institutions during home medical care services，303（26.79%）and 352（31.12%）indicated that the institution
had organized special seminars on home medical care services and received special training on home medical care services，
respectively，853 cases（75.42%）of medical staff were willing to provide home medical care services. The results of binary
Logistic regression analysis showed that the type of primary health care institution with which they worked，the professional and
technical titles currently employed，assessing the safety risk of patients receiving home medical care services，using alarm and
delayed warning devices during home medical care services，and attending special training on home medical care services had
an effect on the medical staff's willingness to provide home medical care services（P<0.05）. Conclusion At this stage，the
safety support for home health care services is insufficient，and various factors affect the willingness of primary health care workers
to provide home health care services. Primary health care institutions should strengthen the assessment of the safety risks of patients
receiving home medical care services，equip the medical personnel who provide home medical care services with alarm and delayed
warning devices，and actively organize special training related to home medical care services and encourage medical personnel to
participate，so as to reduce the risks of medical personnel who provide home medical care services and ensure their personal safety.
【Key words】 Home medical care；Primary medical personnel；Occupational safety；Safety support；Willingness to
serve；Health care facilities；Community health

在人口老龄化持续加剧和慢性病成为人类生命健康 法律法规与管理制度，90.37% 的护士担心在提供居家
主要危险因素的大背景下，老年人尤其是罹患多种慢性 医疗护理服务过程中出现人身安全问题 ［11］ 。既往文献
病的失能或半失能老年人，对日常医疗护理的需求越来 显示，发达国家居家医疗护理服务体系较为完善，且相
越高 ［1-3］ 。受限于家庭照护能力，接受专业的居家医疗 关领域的专家对居家医疗护理服务的安全问题尤为重
护理服务成为老年人的第一选择，其既能缓解老年人到 视，2014 年美国护士协会制定的《家庭健康护理实践
医院“看病难”的问题，又能减轻家庭照护负担，还能 标准》中的首要标准就是进行安全风险评估 ［12-13］ 。目
减轻三级医院接诊压力，逐渐成为社区完善养老服务的 前国内学者对居家医疗护理服务的探讨主要集中在开展
可行途径 ［4-7］ 。近年来，我国政府高度重视推广居家医 现状、患者的需求及其影响因素等方面，较少从服务的
疗护理服务，先后出台了相关文件，鼓励医疗机构尤其 提供者，即医务人员的角度，探讨居家医疗护理服务的
是基层医疗卫生机构开展居家医疗护理 ［8-9］ 。然而对 实施和发展。鉴于基层医疗卫生机构是提供居家医疗护
于医务人员来说，上门提供医疗护理服务效率较低且存 理服务的主体单位，本研究在四川省范围内，调查了基
在风险，较为常见的是职业暴露（锐器伤、血液 / 体液 层医疗卫生机构对医务人员提供居家医疗护理服务的安
污染、高风险传染病等），其次是由社区居民多样性、 全支持，以及基层医务人员提供居家医疗护理服务的意
居家医疗护理服务地点不确定性、安全设备配置短缺、 愿，并探讨其影响因素，为进一步推动居家医疗护理服
居家医疗护理服务培训不足等原因所导致的人身安全问 务持续发展提供参考依据。
题 ［10］ 。对患者而言，由于其身体机能较差、所患疾病 1 对象与方法
较为复杂，故而病情多变，加之输液反应等一系列突发 1.1 研究对象 2021 年 8—10 月，采用便利抽样法调
因素，导致患者在接受居家医疗护理服务的过程中难以 查四川省五大经济区 49 所基层医疗卫生机构，采用方
获得完全满足需要的诊疗，从而引发医疗纠纷。调查显 便抽样法抽取自愿填写问卷的受试者。本研究遵循生物
示，93.02% 的护士担心居家医疗护理服务没有配套的 医学伦理守则，通过四川大学华西医院生物医学伦理审