农村及偏远地区卫生人力资源挽留政策的系统评价再评价

发布时间：2018-10-19 13:18

【摘要】：目的农村及偏远地区卫生人力资源不足已是全球性卫生问题之一,严重影响着各国卫生公平的实现。但是,由于农村及偏远地区卫生人力资源挽留政策的研究证据良莠不齐,各国要循证决策、科学高效地解决这一卫生问题仍然面临着长期而巨大的挑战。本研究采用循证医学的研究方法,全面分析、评价农村及偏远地区卫生人力资源挽留政策的研究证据,以便为决策者和政策研究者提供参考。方法计算机检索PubMed、Cochrane Library、Campbell Library、Web of Science、中国生物医学数据库、相关期刊论文、中文科技期刊全文数据库、中国学术期刊数据库等数据库,世界卫生组织网站和Google学术搜索引擎；手工检索相关研究的参考文献。检索时间截止至2014年3月,不限制文献发表的时间。纳入关于农村及偏远地区卫生人力资源挽留政策的系统评价。从研究基本特征、方法学特征和质量特征方面进行资料提取。采用AMSTAR量表评价纳入研究的方法学质量；以世界卫生组织提供的16条政策建议为基本框架,分类综合、分析纳入研究所针对的挽留政策；利用Excel2003设计资料提取表并进行数据分析。结果根据纳入与排除标准,共纳入系统评价14篇,其中10篇(71.4%)系统评价发表于2009至2013年；2篇(14.3%)系统评价纳入了中低收入国家的原始研究；仅1篇(7.1%)系统评价纳入了随机对照试验研究。质量评价结果显示,这些系统评价的方法学质量等级分别为中(8篇,57.1%)和低(6篇,42.9%)。证据综合分析显示,16条政策建议中,“使各类医学生有在农村地区临床实习的经历”挽留政策的系统评价研究最多(6篇,42.9%);“发展针对于农村卫生工作者的医学继续教育”、“扩大农村卫生工作者的执业范围“引进不同类型的卫生工作者”、“改善卫生工作者及其家人的生活条件并投资于基础设施和服务”、“提高公众认可度”等5项挽留政策尚无系统评价研究。目前尚无系统评价研究16条政策建议之外的其它挽留政策。结论研究表明,大部分农村及偏远地区卫生人力资源挽留政策缺乏循证医学证据的支持；现有研究证据数量少,方法学质量不高；研究类型以观察性研究为主,且主要来自高收入国家。提示我们亟需加强农村及偏远地区卫生人力资源挽留政策的研究,特别要重视针对中低收入国家开展相关研究,强化循证决策意识。
[Abstract]:Objective the shortage of health human resources in rural and remote areas is one of the global health problems, which seriously affects the realization of health equity in various countries. However, due to the mixed evidence of rural and remote health human resource retention policy, countries to make evidence-based decision-making, scientific and efficient solution to this health problem is still facing a long-term and huge challenges. In this study, evidence-based medicine (EBM) was used to analyze and evaluate the evidence of health human resource retention policy in rural and remote areas, in order to provide reference for policy makers and policy researchers. Methods PubMed,Cochrane Library,Campbell Library,Web of Science, Chinese biomedical database, Chinese journal full-text database, Chinese sci-tech journal full-text database, Chinese academic journal database, WHO website and Google academic search engine were searched by computer. Manual retrieval of related research references. The search time is up to March 2014, and there is no restriction on the time of publication. To include a systematic evaluation of health human resource retention policies in rural and remote areas. The data are extracted from basic features, methodological features and quality features. The AMSTAR scale was used to evaluate the methodological quality of the study, the 16 policy recommendations provided by the World Health Organization were used as the basic framework, the classification and synthesis were used to analyze the retention policies targeted by the Institute. Use Excel2003 to design data extraction table and data analysis. Results according to the inclusion and exclusion criteria, a total of 14 systematic evaluations were included, of which 10 (71.4%) were published from 2009 to 2013, 2 (14.3%) included original studies in low- and middle-income countries; Only one (7.1%) systematic evaluation was included in a randomized controlled trial. The results of quality evaluation showed that the methodological quality grades of these systematic evaluations were middle (8, 57.1%) and low (6, 42.9%), respectively. A comprehensive analysis of the evidence shows that among the 16 policy recommendations, the number of systematic evaluation studies on the retention policy "making all kinds of medical students have clinical practice experience in rural areas" (6 articles, 42.9%) and "developing medical continuing education for rural health workers" was the largest. "to expand the practice of rural health workers" and to introduce different types of health workers "to improve the living conditions of health workers and their families and to invest in infrastructure and services", There is no systematic evaluation of the five retention policies. There is no systematic evaluation of retention policies other than 16 policy recommendations. Conclusion most rural and remote health human resources retention policies lack the support of evidence-based medical evidence, the quantity of existing research evidence is small, the quality of methodology is not high, and the main types of research are observational research. And mainly from high-income countries. It is suggested that we need to strengthen the research on the retention policy of health human resources in rural and remote areas, and pay special attention to the relevant research for low- and middle-income countries, and strengthen the awareness of evidence-based decision-making.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.62

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