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目的了解安徽省县/市卫生服务体系内糖尿病和精神分裂症服务提供协作性现状,为推进慢性病分级诊疗试点过程中如何加强服务协作提供建议。方法采用典型抽样方法,对安徽省马鞍山市、肥西县和肥东县卫生体系进行案例分析,在三地调查的机构数量均为11所,以定量和定性研究方法相结合,通过文件分析和专家咨询制定2种疾病诊疗的理论服务包,对医生的问卷调查收集机构提供的数据采用差异分析方法分析服务的差距指数、重叠指数和过度指数。结果 3个卫生体系在糖尿病服务提供中均存在1个断裂点,肥西县和肥东县在精神分裂症服务提供中分别存在2个和3个断裂点;2种疾病的服务协作特点不同,糖尿病服务提供的特点是村级/街道明显过度提供(过度指数≥4.5)和县/市级机构的提供不足(差距指数≥1.5),精神分裂症服务提供呈现基层严重提供不足(差距指数≥6.8)和县/市级机构不足与过度提供并存。结论 3个卫生体系需结合各自的服务协作现状,弥合服务断裂点、机构层面各司其职、体系层面统筹协调,从而推进体系内的服务协作。
Objective To understand the status quo of cooperation in providing services of diabetes mellitus and schizophrenia in the county / city health service system in Anhui Province and to provide suggestions on how to enhance service collaboration in the pilot phase of grading diagnosis and treatment of chronic diseases. Methods A typical sampling method was used to analyze the health system in Ma’anshan City, Feixi County and Feidong County in Anhui Province. The number of institutions surveyed in all three places was 11 and the quantitative and qualitative methods were used to analyze the health system. The expert consults and formulates two kinds of theoretical service packages for the diagnosis and treatment of diseases, and analyzes the service gap index, overlap index and over index for the data provided by the doctor’s questionnaire collection agency by the method of difference analysis. Results There were 1 breakpoint in the three health systems in providing diabetes services. Feixi County and Feidong County had 2 and 3 breakpoints respectively in the service provision of schizophrenia. The service collaboration features of the two diseases were different, Diabetes service delivery was characterized by a significant over-provision of village / street (over-index ≥4.5) and under-provision at county / municipal level (gap index ≥1.5) and a serious under-provision of schizophrenia service delivery (gap index ≥6.8 ) And inadequate and over-provisioning of county / municipal institutions. Conclusion The three health systems need to combine the status quo of their respective service collaboration, bridge the service breakpoint, perform their duties at the agency level, and coordinate at the system level to promote service collaboration within the system.