目的 了解区域内养老机构的住养老人医疗服务需求、医养结合团队的服务提供能力,为进一步厘定服务内容、开展医养结合服务工作奠定基础,也为医养结合服务内容的厘定路径提供参考.方法 2016年11-12月,以上海市嘉定区3家养老机构的住养老人作为需方研究对象、10家嘉定区社区卫生服务中心及上海市嘉定区迎园医院的医养结合团队医护人员作为供方研究对象,开展医养结合服务内容供需方调研工作.问卷主要包括供需方基本情况、7类医养结合服务项目的需方需求/供方服务提供能力,分析需方需求程度(非常高、较高、一般)、供方服务提供能力(较高、一般、较低).结果 需方调查表的Cronbach′s α系数为0.980;供方调查表的Cronbach′s α系数为0.966.养老机构中住养老人对7类医养结合服务项目的总体需求程度为73.23%~96.80%,其中总体需求程度最高的是健康体检(96.80%),其次是健康促进管理(94.98%),最低的是慢病管理(73.23%).单项服务项目需求程度为54.20%~98.70%,其中后3位是慢病管理中的肿瘤患者的建卡(54.20%)、随访(55.10%)及访视与康复指导(55.10%).医养结合服务团队的总体服务提供能力为50.00%~89.24%,其中总体服务提供能力最高的是护理服务(89.24%),其次是其他服务(88.09%),后2位则是康复服务(50.00%)和临床诊疗(70.85%).单项服务项目服务提供能力为42.62%~100.00%,其中后3位是临床诊疗的突发状况临时查房(严重程度-重度)(42.62%)、护理服务的创伤清创包扎(大)(44.44%)及健康体检的B超(47.54%).7类服务项目中,单项服务项目需求非常高且服务提供能力较高的主要为健康促进管理(4/6,66.67%)、健康体检(7/13,53.84%)、其他服务(5/8,62.50%);单项服务项目需求较高或非常高且服务提供能力较高的是护理服务(11/16,68.75%);单项服务项目需求非常高但服务提供能力一般或较低的主要是临床诊疗(6/12,50.00%);单项服务项目需求较高或一般,但服务提供能力一般或较高的主要是慢病管理(13/14,92.86%);单项服务项目需求较高,但服务提供能力较低的则是康复服务(21/21,100.00%).结论 受服务提供能力限制,社区卫生服务中心可为老年人优先提供健康促进管理、护理服务、慢病管理和健康体检服务,社区卫生服务中心应重点加强康复服务和临床诊疗的服务提供能力,最终逐步开展围绕老年人的全生命周期的健康管理.%Objective To acquaint with the medical service demands of the elderly who lived in the pension institutions in the region and the service ability of the medical and nursing integration team,in order to determine the service content,provide the basis for medical and nursing integration service development,and provide reference for the determination of "medical and nursing integration" service content.Methods From November to December in 2016,with the elderly of three pension institutions in Jiading District of Shanghai as demander research objects and the "medical and nursing integration" teams of 11 community health service institutions of Jiading District Yingyuan Hospital of Shanghai Jiading District as the supplier research objects, the supplier-demander research of the "medical and nursing integration" service content was carried out.The questionnaire mainly included the basic information of supplier and demander,the needs of the demander/service capacity of the provider of 7 kinds of items of "medical andn ursing integration" service.The demand levels of the demander(highest,higher,and general) and the service capability of supplier(higher,general and lower) were analyzed.Results The Cronbach′s α coefficient of demander questionnaire was 0.980,and the Cronbach′s α coefficient of the supplier questionnaire was 0.966. The overall demand degree for seven kinds of medical and nursing integration service of the elderly who lived in the pension institutions was 73.23%-96.80%. Among them,the highest overall demands were health examination(96.80%) and health promotion management(94.98%) secondly,and the lower three was chronic disease management(73.23%). The demand degree for single service item was 54.20%-98.70%. Among them,the lower three items were card establishment(54.20%),follow up(55.10%) and visit and rehabilitation instruction(55.10%) for tumor patients in chronic disease management. The total service capability of the medical and nursing integration service team was 50.00%-89.24%. Among them,the highest total service capabilities were nursing service(89.24%) and the other service(88.09%) secondly,and the lower two were rehabilitation service(50.00%) and clinical diagnosis-treatment service(70.85%). The service capability of single service item was 42.62%-100.00%. Among them,the lower three items were temporary round of sudden situation(severe) in clinical diagnosis-treatment service(42.62%),debridement and bandaging of trauma(large) in nursing service(44.44%) and B type ultrasonography in health examination(47.54%). In the seven kinds of the medical and nursing integration services,the single service items with highest demand and higher service capability were health promotion management(4/6,66.67%),health examination(7/13,53.84%),other service(5/8,62.50%). The single service item with higher or highest demand and higher service capability was nursing service(11/16,68.75%). The single service item with highest demand and general or lower service capability was clinical diagnosis-treatment(6/12,50.00%). The single service item with higher or general demand and general or higher service capability was chronic disease management(13/14,92.86%). The single service item with higher demand and lower service capability was rehabilitation service(21/21,100.00%). Conclusion Limited by provision of the service capability,health promotion management,nursing service,chronic disease management and health service should be given priority to the elderly.The community health service center should strengthen the service ability of rehabilitation service and clinical diagnosis-treatment service,and ultimately gradually develop health management throughout the whole life cycle of the elderly.
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