云南省全科医生职业健康状况及影响因素分析
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摘要
目的通过对云南省全科医生职业健康状况的实证研究,了解该省全科医生的健康现状及存在的问题,探究影响全科医生职业健康的因素。方法根据云南省经济社会发展水平和医疗卫生工作基础状况,按好中差采取分层整群抽样方法抽取226名基层全科医生为研究对象,采用自行设计的自填式问卷进行现场调查,统计学方法选用χ~2检验进行单因素统计分析、应用非条件Logistic回归模型进行多因素统计分析,统计检验水准α=0.05,就云南省全科医生职业健康的影响因素进行探讨。结果在200份有效的调查问卷中,云南省全科医生自评处于不健康状态的比例为32.00%(64/200)。非条件Logistic回归分析选入水准为0.05,剔除水准为0.10。该模型χ~2=48.061,P<0.001,Cox&Snell R~2=0.214,Nagelkerke R2=0.299,总验证率达到72.5%。结果显示,晋升机会很少(P=0.009)、因时间压力而烦躁(P=0.009)、工作负担渐重(P=0.028)、工作时间压力大(P=0.032)、回家后易放松(P=0.034)5个因素对云南省全科医生的职业健康有影响。结论云南省基层全科医生的健康状况不佳,与目前基层医疗卫生机构职称晋升机制不完善、名额偏少,相关专业人员短缺致使全科医生工作负担重等情况有直接关系,相关部门应重视并改善全科医生的职业环境,采取有效措施保护全科医生的职业健康。
Objective To investigate the status and relted influence factors tooccupational health of general practitioners(GPs)in Yunnan province on the base of the empirical study of GPs occupational health in Yunnan province. Methods According to the development level of the economic and social and the basic conditions of the medical and health work in Yunnan province. We extracted 226 GPs at the grass-roots level according to the good,medium and poor by using stratified cluster sampling method as the research objects. The spot investigation was conduced by using the self-designed self-reported questionnaire,and the dat were analyzed with χ~2 test and Logistic regression model,statistical test level was α = 0. 05.The relted influence factors to occupational health of GPs were discussed. Results The proportion of the self-assessment in the unhealthy state of 32. 00%(64 /200) in the 200 effective questionnaires. Unconditioned logistic regression analysis for the level of 0. 05,excluding level of 0. 10. The model χ~2= 48. 061,P < 0. 001,Cox&Snell R~2= 0. 214,Nagelkerke R~2= 0. 299,the total verification rate reached 72. 5%. The results of unconditioned logistic regression analysis showed that the following five factors could affect the occupational health of GPs:few opportunities for advancement( P = 0. 009),due to time pressure result in fret( P = 0. 009),increasingly heavy burden on work( P = 0. 028),greatly time pressure( P = 0.032),easy to relax after go home( P = 0. 034). Conclusion The health status of grass-roots GPs in Yunnan province is in poor,the influence factors include the current not perfect title promotion mechanism ingrassroots medical institutions,less places and heavy workload. The relevant departments should improve the professional environment of GPs and take effective measures to protect the occupational health of GPs.
Objective To investigate the status and relted influence factors tooccupational health of general practitioners(GPs)in Yunnan province on the base of the empirical study of GPs occupational health in Yunnan province. Methods According to the development level of the economic and social and the basic conditions of the medical and health work in Yunnan province. We extracted 226 GPs at the grass-roots level according to the good,medium and poor by using stratified cluster sampling method as the research objects. The spot investigation was conduced by using the self-designed self-reported questionnaire,and the dat were analyzed with χ~2 test and Logistic regression model,statistical test level was α = 0. 05.The relted influence factors to occupational health of GPs were discussed. Results The proportion of the self-assessment in the unhealthy state of 32. 00%(64 /200) in the 200 effective questionnaires. Unconditioned logistic regression analysis for the level of 0. 05,excluding level of 0. 10. The model χ~2= 48. 061,P < 0. 001,Cox&Snell R~2= 0. 214,Nagelkerke R~2= 0. 299,the total verification rate reached 72. 5%. The results of unconditioned logistic regression analysis showed that the following five factors could affect the occupational health of GPs:few opportunities for advancement( P = 0. 009),due to time pressure result in fret( P = 0. 009),increasingly heavy burden on work( P = 0. 028),greatly time pressure( P = 0.032),easy to relax after go home( P = 0. 034). Conclusion The health status of grass-roots GPs in Yunnan province is in poor,the influence factors include the current not perfect title promotion mechanism ingrassroots medical institutions,less places and heavy workload. The relevant departments should improve the professional environment of GPs and take effective measures to protect the occupational health of GPs.
引文
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[13]林燕棉,黄翔,余雪强,等.中山市社区卫生服务机构工作人员激励现状及需求调查分析[J].中华全科医学,2015,13(7):1134-1136.
[14]司庆燕,李文,陈士福.规范化培养全科医生需要注意的几个问题[J].医学与哲学(A),2014,35(1):74-76.
[15]张冬莹,郑婵娇,黄翔,等.全科医生职业认同感影响因素分析及策略研究[J].中华全科医学,2014,12(11):1836-1838.
[2]曹兴国,张连仲.郑州市某金融机构职工健康素养分析及促进措施[J].中华实用诊断与治疗杂志,2013,27(7):725-726.
[3]刘志华,钟晓红.全科转岗培训中“双导师制”模式的探索[J].海南医学,2012,23(11):114.
[4]徐丽.大连市某三甲医院医务人员职业倦怠现况调查及影响因素研究[D].大连:大连医科大学,2012.
[5]徐丽,汪俊华,黄文湧,等.贵州省农村基层卫生人员离职意向研究[J].中国初级卫生保健,2015,29(1):27-30.
[6]国家卫生计生委卫生发展研究中心张光鹏,李晓燕,闫丽娜.全科特岗为卫生院解人才荒[N].健康报,2014-10-30007.
[7]郑克彬,李叶桐,李佳林,等.住院医师规范化培训的实践与研究[J].河北医药,2015,37(19):2995-2996.
[8]李怡佳,童亦滨,张爱华,等.贵州省住院医师规范化培训招生情况分析与建议[J].贵州医药,2015,39(6):571-572.
[9]张强,吴少玮,方鹏骞.我国社区卫生人力流动影响因素鱼骨图分析[J].医学与社会,2012,25(1):54-57.
[10]吕秋玲.危害基层医院医护人员职业健康的调查分析[J].中国医药导报,2012,9(1):126-127.
[11]曾丽.基层医疗卫生机构医务人员激励机制研究[D].武汉:华中科技大学,2012.
[12]杨萍,徐玉梅.新医改实施中调动基层医务人员职业积极性的对策研究[J].中国医学伦理学,2012,25(2):205-206.
[13]林燕棉,黄翔,余雪强,等.中山市社区卫生服务机构工作人员激励现状及需求调查分析[J].中华全科医学,2015,13(7):1134-1136.
[14]司庆燕,李文,陈士福.规范化培养全科医生需要注意的几个问题[J].医学与哲学(A),2014,35(1):74-76.
[15]张冬莹,郑婵娇,黄翔,等.全科医生职业认同感影响因素分析及策略研究[J].中华全科医学,2014,12(11):1836-1838.