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目的:探讨上海市提供避孕节育服务各级医疗机构的避孕节育和流产后保健(PAC)服务的管理现状。方法:选取2013年上海市具有开展节育手术和终止妊娠技术服务资质的医疗机构158所,采用定性研究与定量研究相结合的方法对机构内部分避孕节育服务提供者进行个人问卷调查,对部分机构的管理者和服务提供者进行个人深入访谈。结果:81.0%的调查机构自报能够开展PAC服务相关的健康教育、咨询,提供避孕药具和进行流产后随访,62.2%的机构会告知服务对象流产后再次妊娠的风险;全市各级医院计划生育相关技术人员配置紧张,且70.0%以上的提供者对并发症的管理、术后避孕方法的选择以及咨询技巧方面有较大的培训需求;69.0%的机构自报有独立安静的咨询室,84.5%的机构缺乏视听设备,74.3%的机构缺乏健康知识光碟,流产后服务指南和相应的登记本的配置率也较低;当前的PAC服务主要由项目资助方提供资金并进行考核,上级部门和医院缺乏相应的资金支持和考核评估。结论:全面推广PAC服务需要制定统一的技术规范和考核机制,安排定期的PAC服务培训,考虑服务提供者的工作负荷,合理配置人力和物质资源。
Objective: To explore the management status of contraception and postpartum care (PAC) services in Shanghai medical institutions providing contraception services at all levels. Methods: A total of 158 medical institutions with the technical service qualification of birth control surgery and termination of pregnancy in Shanghai were selected in 2013. The questionnaires of some contraceptive service providers in the institutions were conducted by means of qualitative research and quantitative research. Some institutions Managers and service providers for personal in-depth interviews. Results: 81.0% of the investigation agencies reported themselves being able to carry out PAC-related health education, consultation, provision of contraceptives and post-abortion follow-up. 62.2% of the institutions would inform their clients of the risk of miscarriage after pregnancy; More than 70.0% of the providers had great training needs in the management of complications, selection of post-operative contraceptive methods and counseling skills. 69.0% of the agencies reported self-contained and quiet counseling rooms, 84.5% of institutions lacked audio-visual equipment, 74.3% lacked CD-ROMs, and post-abortion service guides and corresponding registration books were also configured at a lower rate. The current PAC service is mainly funded and assessed by project sponsors. And the lack of appropriate hospital funding and assessment assessment. Conclusion: The promotion of PAC services requires a uniform technical specification and evaluation mechanism, regular PAC service training, service providers’ workload, and rational allocation of manpower and material resources.