福建省婚前保健服务质量评价及改进策略研究

发布时间：2018-05-05 05:23

本文选题：婚前保健 + 质量评价　；参考：《福建医科大学》2012年硕士论文

【摘要】：研究目的本课题立足于免费依法婚检政策，从供需双方角度对福建省婚前保健服务结构、过程、结果进行全面的质量评价，探究服务中存在的问题和主要影响因素，进而提出有针对性的质量改进对策与建议。研究方法参考美国学者多那比第安(Avedis Donabedian)提出的“结构—过程—结果”医疗服务质量三维理论，采用文献分析法、观察法、问卷调查法和半结构式访谈法收集资料,并运用统计描述、统计推断、公平性分析等方法进行分析，最后提出有针对性的对策和建议。研究结果1.结构质量：在免费依法婚检政策的推行下，全省婚前保健服务网络已基本建立，但仍存在各地婚检补贴标准悬殊、婚检医师数量和结构分配不均、无专用卫生咨询室和卫生宣教室等问题。2.过程质量：大多数婚检机构虽然按照规范要求开展了婚检服务，但仍存在诸如服务流程不合理、转诊机制不健全、婚检“只检不治”、卫生指导与咨询受忽视和相关宣传不到位等问题。3.结果质量：2010年福建省婚前率为高达97.31%，居全国首位，但供方满意度不高，婚检医师工作满意度量表中各项指标平均分为3.55，其中得分最低的五项依次为报酬（2.88+1.05）、晋升（3.02+0.98）、工作自主性（3.35+0.92）、做不同事的机会(3.39+0.91)和医院政策(3.43+0.9)，同时45岁以上、中级职称为主的婚检医师满意度低于35岁以下、低级职称为主的医师；婚检对象满意度量表中各指标平均分为4.51分，其中评分最低的五项依次为交通便利(4.21+0.95)、候诊条件(4.43+0.81)、候诊时间(4.47+0.81)、宣教40min(4.49+0.78)和及时出报告(4.51+0.79)，不同性别、年龄、居住地的婚检对象满意度得分存在统计学差异。研究结论在免费依法婚检政策推行下，福建省婚前保健服务取得一定的成绩，如婚检率、检出疾病人数上升，医学指导意见充分尊重公民自主权，婚检对象满意度较高等，但仍存在上述列举的问题。为进一步提高婚前保健服务质量，提出以下建议：制定补贴最低标准、加大婚前保健宣传、强化机构规范化建设、优化服务流程、完善转诊机制、开展个性化指导与咨询、加强医师培训和建立健全激励机制等。
[Abstract]:Objective to evaluate the structure, process and results of premarital health care service in Fujian Province from the perspective of supply and demand, based on the policy of free pre-marital medical examination, and to explore the existing problems and main influencing factors in the service. And then put forward targeted quality improvement countermeasures and suggestions. Methods referring to the three-dimensional theory of "structure-process-result" proposed by American scholar Avedis Donabedian, the data were collected by literature analysis, observation, questionnaire survey and semi-structured interview. The methods of statistical description, statistical inference and fairness analysis are used to analyze. Finally, some countermeasures and suggestions are put forward. Results 1. Structural quality: under the implementation of the policy of free and lawful premarital medical examination, the network of premarital health care services in the province has basically been established, but there are still wide disparities in the standard of subsidies for premarital examinations in various localities, and the number and structure of doctors undergoing premarital examinations are not evenly distributed. No special health consultation room and health education room, etc. Process quality: although most premarital inspection institutions have carried out premarital examination services in accordance with the standard requirements, there still exist such services as unreasonable service flow, imperfect referral mechanism, and "only inspection without treatment". Health guidance and counseling neglected and related issues such as inadequate publicity. 3. Results: the premarital rate of Fujian Province in 2010 was as high as 97.31%, ranking first in the country, but the satisfaction of the suppliers was not high. The average score of the five indexes in the scale was 3.55, among which the lowest scores were: remuneration 2.88 1.05, promotion 3.02 0.98, job autonomy 3.350.92, opportunity to be non-colleagues 3.39.91) and hospital policy 3.43 0.9, at the same time, over 45 years old. The satisfaction degree of the premarital examiner with intermediate professional title was lower than that of the doctor under 35 years of age, and the average score of each index in the satisfaction scale of premarital examination object was 4.51. Among them, the five items with the lowest score were convenient transportation 4.29.5, waiting time 4.47.0.81g, waiting time 4.47.881, and timely report 4.51.0.79. there were statistical differences among different sex, age and place of residence. Conclusion under the implementation of the policy of free and legal premarital medical examination, Fujian Province has made some achievements in premarital health care services, such as the rate of premarital examination, the increase in the number of patients detected, the full respect of medical guidance for the autonomy of citizens, and the higher satisfaction of the premarital examination objects, etc. However, there are still problems listed above. In order to further improve the quality of premarital health care service, the following suggestions were put forward: establishing the minimum standard of subsidy, increasing premarital health care propaganda, strengthening the standardized construction of institutions, optimizing service flow, perfecting referral mechanism, and carrying out individualized guidance and consultation. Strengthen the training of doctors and establish a sound incentive mechanism.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R169.1

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