| BackgroundThe current model of providing medical and health services in China is still hospital-led,treatment-centered self-sufficient,resulting in a fragmented and compartmentalized medical and health service system,which has weakened its service capacity and made it difficult for the people to obtain comprehensive,coordinated,high-quality and efficient health services.The implementation of the "Healthy China" strategy proposed in the report of the 19 th Party Congress calls for the improvement of national health policies and the provision of comprehensive health services for the people.In this context,there is an urgent need to integrate quality and efficient medical services with strong public health services,and the "integration of medicine and prevention" has emerged.Existing practices have confirmed that the implementation of integration of medicine and prevention is conducive to promoting the integration of primary medical and health resources,meeting the growing demand for health services and improving the satisfaction of the people,and has become an important way to safeguard the health of the people.However,the integration of medicine and prevention is still in its initial stage,and there are difficulties and shortcomings in terms of policies and regulations,management system,team,and the concepts of medicine and prevention.Therefore,this study examines the current situation of the implementation of the integration of medicine and prevention in Anhui Province and discusses the current problems and influencing factors to provide a reference basis for further promoting the integration of medicine and prevention.MethodsThrough literature research,the current policy documents,public reports and research literature related to the integration of medicine and prevention were sorted out and summarised,and after several rounds of expert discussions,questionnaires on the integration of medicine and prevention between medical staff and residents were designed and developed by ourselves.Using typical sampling and stratified sampling methods,three counties/districts at northern,central and southern Anhui were selected.In-depth interviews were conducted to understand the implementation of integration of medicine and prevention in the surveyed areas and summarised using the thematic framework method.Using the questionnaire,the perceptions,behaviors and satisfaction of integration of medicine and prevention for medical staff and residents were investigated and analyzed using general descriptive analysis,chi-square test,factor analysis and binary logistic regression.Results（1）The current situation of the implementation of the integration of medicine and prevention in the surveyed areas: a)Policy documents: District T has issued special policy documents about the integration of medicine and prevention,while the other two districts still lack special policy documents.b)Management system: the main measures include depending on an integrated health service system,and setting up special departments,etc.c)Professional teams: family doctor teams are the main providers of the integration of medicine and prevention services at present.d)Service contents: the main contents of the integration of medicine and prevention include publicizing health knowledge,chronic disease prevention and control,infectious disease prevention and control,maternal and child health,Chinese medicine services,mental health,etc.e)Guarantee mechanism: including incentive mechanism,staff training,information construction,etc.f)Publicity measures: health education for residents and relevant training for medical staff.（2）Supplier of the integration of medicine and prevention in survey areas: a)Cognition: 89.8%% of medical staff understand the integration of medicine and prevention;50.4% of medical staff consider the integration of medicine and prevention very important;7.2% of medical staff are not clear about their responsibilities in the integration of medicine and prevention;most medical staff believe that the integration of medicine and prevention is conducive to improving the health of residents;lack of financial support is considered to be the most important factor affecting the implementation of the integration of medicine and prevention.b)Work situation: The most important way for medical staff to provide services of integration of medicine and prevention is to provide guidance on healthy lifestyles and popularise health knowledge;95.5% of medical staff said they were competent in the integration of medicine and prevention;most medical staff had a need to improve their knowledge of general medicine;the overall participation of medical staff in training was good.c)Satisfaction and influencing factors: The overall satisfaction score of medical staff with the integration of medicine and prevention was 4.02±0.78;age,personal income and cognition were the factors affecting the overall satisfaction of medical staff;the results of factor analysis showed that the overall satisfaction of medical staff with the integration of medicine and prevention mainly consisted of four dimensions: salary,career development,sense of work satisfaction and job stress;among them,salary has the greatest influence on the overall satisfaction of medical staff,followed by career development and job stress.（3）Demander of the integration of medicine and prevention in survey areas: a)Cognition: 84.3% of the residents did not know about the integration of medicine and prevention;the main channels of understanding were medical staff and the Internet;56.8% of the residents thought that prevention services were more important than medical services.b)Using of services: 46.3% of residents have signed up with a family doctor,and only 0.6% of those who have received family doctor services are dissatisfied with the services;31.7% of residents are reluctant to participate in health promotion activities,and 59.0% of residents rarely participate in such activities.c)Satisfaction and influencing factors: The overall satisfaction score of residents with the integration of medicine and prevention was 4.00±0.75;age,place of residence,marital status and health status were the factors influencing residents’ overall satisfaction;the results of factor analysis showed that residents’ overall satisfaction with the integration of medicine and prevention mainly consisted of four dimensions:convenience and accessibility of service,service attitude,service costs,and service level.Among them,service costs had the greatest impact on the overall satisfaction of residents,while convenience and accessibility of service,service attitude and service level had no statistically significant impact on overall satisfaction.Conclusion（1）Surveyed areas in this study have carried out preliminary exploration of the integration of medicine and prevention,including the formulation of relevant work plans and implementation programs,strengthening collaboration and cooperation,bringing into play the professional advantages of family doctor teams,providing comprehensive and life-cycle health services,and improving the external support environment,but it still faces problems such as a lack of policy support,guarantee mechanism is difficult to meet the needs of practical work,and insufficient publicity efforts.（2）Medical staff have a good cognition of the integration of medicine and prevention.The provision of the integration services of medicine and prevention is good.The overall satisfaction of medical staff with the integration of medicine and prevention is high.Career development,salary,and job stress are the main factors affecting the overall satisfaction.（3）Residents’ cognition of the integration of medicine and prevention is poor.The use of integration services of medicine and prevention is average.The overall satisfaction of residents with the integration of medicine and prevention is high.Service costs are the main factors affecting the overall satisfaction.（4）Strategies for improving the integration of medicine and prevention are proposed:strengthening top-level design and improving policies and regulations;improving the management system and strengthening collaboration and cooperation;strengthening team building and improving the incentive mechanism;expanding service contents and improving service levels;improving the guarantee mechanism and improving the external environment;and increasing publicity and raising cognition. |
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