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目的探讨四川省少数民族地区县乡村一体化医疗模式的实施效果,为进一步的卫生决策提供参考。方法查阅相关文件和问卷调查搜集县乡村一体化实施前后县乡村三级医疗机构相关资料,采用倍差法对各级医疗机构卫生人员、设备设施和医疗服务等方面的变化情况进行评价。结果县乡村一体化实施初期,实施组在妇幼健康状况(新生儿死亡率下降了1.82‰,孕产妇死亡率下降了65.47/10万)、医疗卫生人员、设备设施、基本医疗卫生和基本公共卫生服务有所改善,但存在以下问题:民族地区医疗卫生技术人员相对缺乏(每千人口执业(助理)医师数和每千人口注册护士数均小于1)、基本医疗卫生服务地区间差异大、双向转诊存在挑战以及公共卫生基础薄弱和发展不均衡。结论县乡村一体化的实施一定程度上促进了县乡村三级医疗机构综合服务能力的提升,但三级医疗网络仍需进一步完善。
Objective To explore the implementation effect of integrated medical model of counties and villages in minority areas of Sichuan Province and provide reference for further health decision-making. Methods The relevant documents and questionnaires were collected to collect the relevant information of county and township tertiary medical institutions before and after the implementation of the integration of counties and villages. The double difference method was used to evaluate the changes of health personnel, equipment and facilities and medical services in medical institutions at all levels. Results In the initial stage of the integration of county and village, the implementation group had a great improvement in the health status of women and children (the neonatal mortality rate dropped by 1.82 ‰ and the maternal mortality rate dropped by 65.47 / 100000); the medical and health workers, equipment and facilities, basic health care and basic public health Services have been improved, but the following problems exist: the relative shortage of medical and health technicians in ethnic areas (the number of practicing (assistant) doctors per 1,000 population and the number of registered nurses per 1,000 population are all less than 1), there are large differences in basic medical and health service areas, There are challenges to referrals and weak public health infrastructure and uneven development. Conclusion The implementation of the integration of counties and villages has promoted the improvement of comprehensive service capacity of tertiary medical institutions in county, village and townships to a certain extent, but the tertiary medical networks still need to be further perfected.