Zhongguo quanke yixue (Feb 2024)
Investigation on the Situation of Primary Health Care Institutions and Home-based Medical Service in Sichuan Province
Abstract
Background In the context of increasing aging, diversified medical needs of the elderly and the constrains of medical resources, the demand for home-based medical services is increasing. Therefore, the development of home-based medical services are strongly encouraged in China. Sichuan Province, as a pilot area for geriatric home-based medical services, is currently operating mainly in primary health care institutions, and it is necessary to explore its condition and the current situation of service development. Objective To investigate the condition and current situation of home-based medical service of primary health care institutions in Sichuan Province, so as to provide reference for further promoting the standardization and development of home-based medical services. Methods From August to October 2021, a convenience sampling method was used to select the relevant persons in charge of 62 primary health care institutions in 7 cities in Sichuan Province as the subjects. Through self-designed questionnaires, data collection and survey analysis were conducted on the general information, human resources, the development of home health care and obstacles of the situations. Results Among the 62 primary health care institutions, the number of full-time medical staff varied widely, ranging from 10 to 316, with a median of 40 (40). The average proportion of medical staff to full-time employees was (84.9±11.3) %; the median percentage of physicians with junior titles or lower was 45.5% (24.2%), and the median percentage of nurses with junior titles or lower was 71.9% (34.2%) ; the medical-to-nursing ratio ranged from 0.43 to 2.63, with an average of (1.44±0.50). The differences were statistically significant when comparing the participation in accreditation of graded hospitals and part-time medical and nursing staff with the different locations of the institutions (P<0.05). There was a statistically significant difference in the service areas of the institutions when comparing the names of institutions, participation in the accreditation of graded hospitals, with inpatient beds, the proportion of medical staff, the ratio of doctors to nurses, the proportion of professional titles of medical staff (P<0.05). Fifty-one (82.3%) institutions had carried out home-based medical services, and there was an effect of chronic disease management on the development of home-based medical services (P<0.05). The service duration of 26 institutions (50.9%) was less than 3 years, 31 institutions (60.8%) were mainly serving elderly patients ≥60 years old with chronic diseases, 35 institutions (68.7%) had a workload of ≤1-2 days/week, and the service pathway was dominated by family doctor contract service (98.0%). The top three obstacles to the development of the home-based medical services were insufficient human resources, lack of corresponding standards and norms, and inadequate appropriate supporting policies. Conclusion The condition of primary health care institutions were distinct in different regions and service areas. The home-based medical services were widely available in Sichuan Province, but there is still room for improvement in terms of service forms, service hours and workload. It is suggested that all institutions should pay attention to the problems facing the current development according to their own conditions, improve the standards and norms related to home-based medical services, pay attention to chronic disease management and the construction of talent team, and further promote the rapid development of home-based medical services.
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