医务人员主动提供艾滋病转介服务状况及影响因素调查

doi:10.3969/j.issn.1006-3110.2019.09.010

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摘要目的了解医疗卫生机构的医务人员主动为HIV/AIDS患者提供转介服务的现状及存在问题,探讨艾滋病转介工作开展的影响因素,为当地合理制定艾滋病防控策略提供依据。方法采用问卷调查的方法,2018年7－8月,在广西南宁市15个县(区)的20家医疗卫生机构249名医务人员进行面对面问卷调查,分析艾滋病转介服务的开展情况。结果研究对象对其发现或管理的HIV/AIDS患者均全部提供转介服务的比例为56.63%。提供转介服务的比例中,按照机构级别分析,最高是省级机构(67.12%),最低是县(区)级机构(47.46%),但差异无统计学意义(χ²=5.463,P=0.131);按照机构性质分析,最高是疾病预防控制中心(88.23%),最低是综合医院(52.24%),差异有统计学意义(χ²=7.980,P=0.046)。“医生忘记转介”是未提供转介服务的主要原因(占88.89%)。单因素分析显示,从事艾滋病防控工作年数、所在的机构性质、是否接受过艾滋病防治知识与转介工作技能培训等因素,与医务人员是否主动为发现的患者提供转介服务有统计学关联(P<0.05)。多因素分析显示,机构性质是疾病预防控制中心(OR=10.426, 95%CI: 1.745～62.294)、从事防艾工作年数为5年及以上(OR=2.598, 95%CI: 1.447～4.666)、接受过艾滋病防治知识与转介技能培训(OR=12.066, 95%CI: 4.518～32.223)是医务人员主动提供转介服务的积极因素。结论医务人员主动为患者提供转介服务的比例仍较低。“医生忘记转介”是未提供转介服务的主要原因。为保证艾滋病转介工作的有效开展,需建立首诊医生负责制和转介工作考核、奖励机制;同时进一步加强医务人员尤其是综合医院和从事艾滋病防控工作年数低的医务人员培训, 激励其主动为患者提供转介服务,确保HIV/AIDS患者有效管理和治疗。

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	农丽萍
	何波
	汤洪洋
	黎火佳
	岑平
	林倩
	李斯斯
	徐红
	姚敏
	覃威翱
	邓小芳

关键词 ：医疗卫生机构, 转介服务, 艾滋病, 影响因素

Abstract：Objective To investigate the current situation and existing problems of referral services actively provided by medical staff in medical institutions for HIV/AIDS patients, to explore the factors influencing HIV/AIDS referral work, and to provide a basis for rationally formulating HIV/AIDS prevention and control strategies in local areas. Methods A face-to-face questionnaire survey was conducted among 249 medical professionals from 20 medical institutions in 15 counties (districts) in Nanning city, Guangxi province in July-August 2018, and the development of HIV/AIDS referral services was analyzed. Results The proportion of all HIV/AIDS patients who were found or managed and referred by the participants was 56.63%. Analysis of the institutional levels based on the proportions of providing referral services indicated that provincial institutions were the highest (67.12%), while county (district) institutions were the lowest (47.46%), without a statistically significant difference (χ²=5.463, P=0.131). Analysis of the nature of the institutions revealed that centers for disease control and prevention (CDCs) were the highest (88.23%), while general hospitals were the lowest (52.24%), with a statistically significant difference (χ²=7.980, P=0.046). The main reason for doctors’ not providing referral services was to forget to refer (88.89%). Univariate analysis showed that the years engaged in AIDS prevention and control work, the nature of institution, whether receiving training regarding AIDS prevention and control knowledge and referral skills, and other factors were statistically related to whether medical staff actively offered referral services to the patients (P<0.05). Multivariate analysis showed that the nature of the institution was CDC (OR=10.426, 95%CI:1.745-62.294), having 5 years and above working experience in anti-HIV/AIDS (OR=2.598, 95%CI:1.447-4.666) and receiving training in knowledge and skills of AIDS prevention and control (OR=12.066, 95%CI:4.518-32.223) were positive factors for medical staff to actively provide referrals services. Conclusions The proportion of medical staff to actively provide HIV/AIDS referral services for HIV/AIDS patients is still lower. The main reason for doctors’ not providing referral services is to forget to refer. To make certain the effective implementation of HIV/AIDS referral, it is necessary to establish the system of first doctor responsibility and referral assessment and reward, simultaneously further enhance the training among medical staff, especially in medical professionals from general hospitals and with less working experience in HIV/AIDS prevention and control, encourage them to actively provide targeted referrals for patients, and ensure the effective management and treatment of HIV/AIDS patients.

Key words： medical and health institution referral service AIDS influencing factor

收稿日期: 2018-11-22

R512.91

基金资助:广西卫生和计划生育委员会科研课题(Z20181042);广西卫生和计划生育委员会科研课题(Z20180347)

作者简介: 农丽萍(1966-),女(壮族),本科学历,主任医师,主要从事艾滋病性病预防控制研究工作。

引用本文:

农丽萍, 何波, 汤洪洋, 黎火佳, 岑平, 林倩, 李斯斯, 徐红, 姚敏, 覃威翱, 邓小芳. 医务人员主动提供艾滋病转介服务状况及影响因素调查[J]. 实用预防医学, 2019, 26(9): 1059-1063. NONG Li-ping, HE Bo, TANG Hong-yang, LI Huo-jia, CEN Ping, LIN Qian,LI Si-si, XU Hong, YAO Min, QIN Wei-ao, DENG Xiao-fang. Status and influencing factors of HIV/AIDS referrals actively offered by medical staff. , 2019, 26(9): 1059-1063.

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