| Objectives : The purpose of this study is to understand the current situation of the development of community health service (CHS) institutions and patient satisfaction in Nanning City and to find out problems existing in construction and service, and put forward the policy recommendations,in order to provide scientific basis for the government to develop regional health planning and improve the community health service system in the future.Methods: The basic information of all CHS institutions in Nanning city was collected by self-made questionnaires in the way of the census survey.Using stratified sampling investigation method, CHS institutions were randomly selected (CHS center 6; CHS station 6) and patients were randomly selected in each CHS institutions (CHS center 30; CHS station 20),a total of 300. A self-designed questionnaire was used to collect patients' basic situation,understanding, utilization and satisfaction.Results: (1) In 2014, there were a total of 82 CHS institutions (38 CHS centers and 44 CHS stations) in Nanning City. The average service population in CHS centers and CHS stations were respectively 41 731.5 and 10 522.5. 26.32%CHS centers and 63.64% CHS stations were held by social power.(2) The setting rate of general clinic, Chinese medicine clinic in CHS institutions was high, accounting for more than 95%. In addition to the community health service stations to prevent health care departments, other departments set rates above 70%; CHS institutions most of the medical equipment is equipped with more than 80%. 11 CHS centers among 38 CHS centers set up sickbeds and only two service centers conformed to the standard.55.26% CHS centers and 56.82% CHS stations were set up observation beds.21.05% CHS centers' housing area were<1400 square meters and 9.09% CHS stations<150 square meters. The main source for business house was hired and more than 60% was self -raised funds.(3)The average number of general practitioners (GPs) in CHS centers and CHS stations were respectively 6.50 and 2.36. The average number of public health doctors in CHS centers and CHS stations were respectively 1.97 and 0.93.GPs and nurses were 1:2.19 in CHS centers and CHS stations. Health care ratio was 1:0.99 in CHS centers and 1:1.01 in CHS stations. Most of workers in CHS institutions were Primary title and college degree.(4)In 2014, the average income in CHS centers and CHS stations were respectively 7.11 million Yuan and 1.43 million Yuan, the average total spending respectively 5.34 million Yuan and 1.18 million Yuan and the financial surplus were respectively 1.75 million Yuan and 0.25 million Yuan.CHS centers total outpatient in Nanning City accounted for 22.55% of the total number of outpatient and emergency patients of Guangxi all CHS centers.Hospitalized patients accounted for Guangxi all CHS center patients' admission number of 29.49% and per 100 noble emergency admission number is 0.5.Patients were transferred the higher level of medical institutions respectively 12384 in CHS centers and 9516 in CHS stations, while patients were transferred to CHS centers only 3 467 and CHS stations 1634. CHS stations didn't carry out preventive care, maternal and child care and family planning and other parts of the basic public health projects.(5)Patients were given priority to with the elderly and low degree of culture of women in satisfaction survey. Only 40.28% patients were known very well for CHS institutions and 53.82% patients used in 4 times and above. 75.35%patients walked to CHS institutions less than 20 minutes and 69.10% patients waited less than 10 minutes when they saw doctors. The mainly medical services for patients were hypertension, upper respiratory tract infections and so on.(6)The total satisfaction was 3.71 + 0.56 points. The lowest satisfaction was medical facilities (49.31%) and the highest satisfaction was service attitude(89.08%). In single factor analysis, age and other eight factors were statistically significant influence on the overall satisfaction. Degree of culture and other four factors were into the regression model in multiple linear regressions, as follows:Y=5.152-0.110X1-0.302X2-0.064X3-0.065X4-0.161X5Conclusion : (1) Achievement: CHS institutions were diversified development, and further optimize the allocation of resources. Department setting and part of medical equipment basically reach the standard of CHS institutions construction. The number of GPs basically conforms to the requirements of the standard. CHS institutions are in good operation, not indebted and good public benefit. It can provide a good basic medical services and basic public health services. The accessibility and convenience of community health CHS institutions are good and the satisfaction of patients to medical staff s service attitude is better.(2) Problems and shortages: In 2014, the number of CHS institutions and configuration plan compared to the target, there is still a certain gap. The fixed assets of the minority CHS institutions are not up to standard requirements and the quantity of human resources is relatively insufficient. Two-way referral is not smooth and service function needs to be completed. There are few channels for patients to understand CHS institutions and low level of understanding.Patients' overall satisfaction is not high, especially in the medical equipment and facilities drug prices and types etc.Policy suggestion: In brief, to achieve the original planning objectives and meet the health needs of community residents, it is necessary to further improve the community health service network, increase the number of CHS institutions,so the layout is more reasonable. At the same time, it is necessary to strengthen policy support, increase financial input, improve community health service management level and guarantee conditions, actively carry out publicity and education on community health service policy, strengthen professional training for medical personnel, improve the ability of community health services. |
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