| Background:As an important part of China’s medical and health care,traditional Chinese medicine(TCM)plays a unique role in maintaining and promoting people’s health.In recent years,with the popularity of the concept of "health care" and "treating the sick",the demand for TCM-related services has been increasing.The further promotion of the hierarchical medical system also puts forward higher requirements on the capacity of primary health services.However,the capacity of primary TCM services in China is still weak,TCM treatment resources are distributed in an inverted triangle,and the satisfaction level and willingness of first consultation are not high,indicating that there is still room for improvement in the capacity and quality of community TCM services.Scientific evaluation of the capacity of primary TCM services through the evaluation system can identify its problems and help health administration departments to target their management,improve the capacity,efficiency and quality of community TCM services,and meet the health needs of residents.Therefore,a scientific and reasonable evaluation system of community TCM service capacity is indispensable.Objective:By analyzing the current situation of research on community health service evaluation and TCM service evaluation at home and abroad and applying relevant research theories and methods,the connotation framework and evaluation index system of TCM service capacity of community health institutions are constructed.To carry out empirical evaluation for the TCM service capacity of community health institutions,analyze the current situation of community TCM services and the influencing factors,propose suggestions for improving service capacity and quality,expand the evaluation methods of community TCM services,and provide reference for health administration departments to strengthen management.Methods:1.On-site survey method:Some community health service institutions in Guangzhou were selected for the empirical study,and a questionnaire was established based on the constructed evaluation index system to conduct an on-site survey on the TCM services in community health service institutions in the previous year.2.Qualitative research methods:(1)Grounded Theory Methodology(GTM):based on the research method of GTM,we designed a semi-structured interview outline,conducted interviews with informed individuals,analyzed interview data and coded them at three levels,and constructed a connotation framework of community TCM service capacity;(2)Literature analysis method:Searching domestic and international literature,research reports and policy documents with key words such as "evaluation","primary health care","primary health service","community health service"," TCM","evaluation",etc.to understand the current status of research on community health service and evaluation of community TCM service.;(3)Delphi method:Invite experts in the field of health management and TCM to carry out two rounds of expert consultation and construct a community TCM service capacity evaluation index system.3.Quantitative analysis method:(1)Sample selection method:semi-structured interviews were conducted with 19 informants using purposive,snowball sampling;6 empirical study samples were selected through multi-stage random sampling;(2)Mathematical statistical method:the rank-sum ratio method and the comprehensive index method were used to conduct a comprehensive evaluation of the TCM service capacity of selected community health service institutions.Results:1.Constructing a connotation framework of community TCM service capacity:In this study,a total of 19 original interview data were obtained using the research method of GTM,of which 15(80%)were used for theory construction and the remaining 4(20%)were used as theoretical saturation test data.After coding the original interview data at three levels using NVivo software,a connotation framework for evaluating the service capacity of community TCM containing three dimensions was constructed,i.e.,community TCM service capacity is the result of the joint action of service thrust,service pull and service motivation.2.Construction of community TCM service capacity evaluation index system:A community TCM service capacity evaluation index system containing three primary indicators,six secondary indicators and 31 tertiary indicators was established through GTM,literature analysis method and Delphi method,with a Kendall coefficient of 0.425(P<0.001)and an authority coefficient of 0.769.The weights of each indicator in the index system were calculated based on expert opinions.3.Empirical research analysis:Six community health service institutions in three districts of Guangzhou,Tianhe,Baiyun and Haizhu,were selected through multi-stage random sampling,and the constructed evaluation index system was used to form a questionnaire to conduct an empirical study.The rank-sum ratio method and the comprehensive index method were used to evaluate the TCM service capacity of community health service institutions.The regression equation of the rank-sum ratio method was y=0.034+0.057×Probit(F=25.307,P<0.01);the six institutions were divided into three groups of better,average and worse according to the probit value,including one better group(X6),five average groups and no worse group.The ranking results of the composite index method were basically the same as the rank sum ratio method,and the community health service organization X6 had the highest composite index of TCM service capacity.The reliability and validity analysis of the questionnaire showed that the Cronbach alpha coefficient was 0.707,the Guttman Split-Half coefficient was 0.577,and the Spearman Brown coefficient was 0.682.The positive coefficient of the experts was high,and the consultation results were more reliable,suggesting that the reliability of the questionnaire content was acceptable.4.Suggestions for optimizing the TCM service capacity of community service institutions in Guangzhou:Through analyzing the interview data and combining with the empirical study,the following suggestions were made to optimize the TCM service capacity of community health service institutions in Guangzhou:(1)relying on high-quality medical,educational and scientific research resources to enhance the quantity and quality of community TCM talents(2)building a fair and reasonable incentive mechanism to enhance the motivation of community TCM personnel to serve;(3)based on the advantages of location,strengthening the construction of community TCM service informationization.Conclusions:Based on the background of in-depth promotion of graded diagnosis and treatment and increasing demand for primary TCM services,this study applies GTM to construct a connotation framework of community TCM service capacity,which consists of three parts:service thrust,service pull and service motivation.The Delphi method was used to construct the community TCM service capacity evaluation index system,and the expert authority coefficient and opinion consistency coefficient of the index system met the research requirements,and the constructed community TCM service capacity evaluation index system was relatively reliable.The empirical study found that the TCM service capacity of community service institutions in Guangzhou is in the middle to upper level.Based on the results of the empirical study combined with the situation of Guangzhou city,suggestions were made to optimize the capacity of community TCM services in three aspects:talent,incentive mechanism and informationization.However,due to the limitation of the survey capacity,there is a lack of regional representation of interviewees and consulting experts,and the sample size in the empirical stage is small.The subsequent study will improve the representativeness of the research sample and the validity and applicability of the index system by optimizing the semi-structured interview outline design,expanding the depth and breadth of Delphi method and semi-structured interviews,improving the sampling method of the empirical study,and increasing the number and geographical breadth of the collaborating units of the empirical study. |
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