老年医学从业人员对医养结合的认识及我国开展医养结合现况的调查报告

Survey on awareness of combination of medical care and nursing service in geriatric staffs and its current status in China

摘要:

目的 了解目前我国老年医学从业人员对医养结合的认识及我国开展医养结合的现况。方法 2015年9月至2015年12月期间采用现况调查的方法，利用中国老年医学学会平台，对学会内从事老年医学各领域的委员进行问卷调查，共回收有效问卷1232份。结果 调查对象来自全国31个省市。724%的调查对象年龄≥40岁，703%的调查对象拥有硕士及以上学历，766%的调查对象拥有高级职称。超过2/3的调查对象对医养结合的概念和服务内容有一定的了解，约有半数的调查对象参与到医养结合服务中。>950%的调查对象认为有必要针对老年医学人才培养设置国家统一教材、培训基地、专科规范化培训和照护人员培训。而实际上仅有548%的医院针对护理人员开展老年专科培训、367%的医院针对护工开展老年专科培训，拥有教材的比例更低。共有175个（349%）医疗机构开展了医养结合服务，其形式主要集中在出院延伸服务（623%）、与养老机构合作（571%）、内设养老床位（406%）、配置家庭医生（383%）和开办养老机构/护理院（366%）。服务对象主要集中在出院患者（777%）、社区老年人（697%）和养老机构的老年人（600%）。具体服务内容包括慢病管理（880%）、指导用药（874%）、体检（783%）、康复与辅具适配（571%）、精神慰藉（531%）和临终关怀（526%）。绝大部分老年科及延伸服务入不敷出，需要医院和地方政策支持。结论 目前我国老年医学从业人员对医养结合的认识和了解较好，但国家尚缺乏针对老年医学人才、基地等方面的配套建设。仍有较多的医疗机构未开展医养结合相关服务，且缺乏对医护人员的培训与人才建设体系。

Abstract:

Objective To investigate the awareness of combination of medical care and nursing service in geriatric personnel and its current status in China. Methods A cross-sectional survey was conducted in all the members of Chinese Geriatrics Society from September to December 2015. A total of 1232 valid questionnaires were included in the analysis. Results The 1232 respondents were from 31 provinces and municipalities. There were 724% of them aged ≥40 years, 703% having master degree or above, and 766% having senior professional titles. More than 2/3 of the respondents had certain awareness on the concept and content of combination of medical care and nursing service, and about half of them had been involved in the corresponding work. More than 95% of the respondents thought it was necessary to set up national unified teaching materials, training bases, and standardized and specialist training programs for medical staffs who were engaged in geriatric medicine. However, only 54.8% of the questioned hospitals had carried out specialist training for nurses, 36.7% for nursing assistants, and the amount of those with teaching materials was even lower. A total of 175 (34.9%) hospitals had carried out combination of medical care and nursing service, mainly in the forms of extension service after hospital discharge (62.3%), cooperation with nursing homes (57.1%), reservation of nursing home beds for the elderly (40.6%), providing family doctors (38.3%) and setting up nursing homes (36.6%). The service objects mainly consisted of discharged patients (77.7%), community elderly (69.7%) and elderly in the nursing homes (60.0%). Special services included chronic disease management (88.0%), guidance of medication (87.4%), physical examination (78.3%), rehabilitation and aids adaptation (571%), spiritual consolation (531%) and hospice care (526%). Most of the geriatric departments and their extended services were umable to make ends meet, and need local policy support. Conclusion Though the geriatric staffs have well awareness and understanding on the combination of medical care and nursing service, it is still lack of national supporting on the construction for the personnel, training bases and other aspects. There are still many medical institutes having not provided the combination of medical care and nursing service and lacking of training and personnel development system for geriatric staffs.