杭州市居家养老的医养护结合现状调查

王结胜; 徐晓芳; 李宏春; 金东

doi:10.16766/j.cnki.issn.1674-4152.002026

杭州市居家养老的医养护结合现状调查

doi: 10.16766/j.cnki.issn.1674-4152.002026

1.
浙江省立同德医院老年医学科，浙江杭州 310012
2.
浙江警官职业学院基础部，浙江杭州 310018

基金项目:

浙江省民政政策理论研究规划课题 ZMZC201967

详细信息

通讯作者:
王结胜, E-mail: wwjjss2000@163.com

中图分类号: R49 R161.7
计量
- 文章访问数: 81
- HTML全文浏览量: 21
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-17
- 网络出版日期: 2022-02-16

Investigation and research on the current situation of the combination of medical care and maintenance for the aged cared by home in Hangzhou

1.
Department of Geriatrics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China

摘要

摘要: 目的调查杭州市居家养老的医养护结合现状，发现存在的供给和需求不匹配问题，从而提出开展针对性养老服务和养老服务供给侧改革的建议。方法于2019年对杭州市西湖区和江干区共5个社区的居家养老人群，共调查942人，按照日常生活能力量表评分结果分为自理组(707人)和失能组(235人)进行问卷调查和实际走访调查，以了解医养护结合需求和供给现状。结果居家养老人群中失能组的年龄比自理组的年龄大(P < 0.05)；2组性别比例差异无统计学意义(P=0.273)，均为女性较多；2组的生活照料人员比较差异有统计学意义(P < 0.05)，老年人的主要生活照顾者是伴侣，失能老人独居比例下降，依靠子女和保姆比例增加；除了慢病管理、建立电子档案和健康知识教育外，老年人接受其他项目的公共卫生服务比例均 < 50%；失能老年人接受上门服务、家庭病床、助医服务的比例 < 50%，提示基本医疗的可及性差；接受管道护理、压疮护理服务比例 < 50%，提示老年专科特色医疗护理欠缺；除了急慢性颈肩腰腿疼痛，接受其余康复项目服务的比例均 < 50%，提示专业的康复缺乏。结论通过对杭州市居家养老的医养护结合现状调查，发现存在供给与需求不匹配问题，建议有条件的单身人士尽可能结婚，以应对将来老年期的生活照料问题，建议社区养老服务中心增加上门服务和短期照料服务以增强家庭养老能力；建议社区卫生服务机构提高针对老年人公共卫生服务的质量，提高基本医疗的可及性，培训老年专科护士，建设专业康复科室。
- 居家养老 /
- 医养护结合 /
- 调查研究
Abstract: Objective To investigate the current situation of medical care for the aged at home in Hangzhou and find out the mismatch between supply and demand, so as to put forward suggestions for carrying out targeted pension service and pension supply-side reform. Methods In order to understand the current situation of demand and supply of medical care combined with maintenance, a questionnaire survey and an actual interview survey were conducted among the elderly in five communities in Xihu District and Jianggan District of Hangzhou in 2019. According to the scoring results of the activity of daily living (ADL), the elderly population was divided into self-care group and disabled group. Results The disabled group was older than the self-care group (P < 0.05). There was no significant difference in the sex ratio between the two groups (P=0.273). Major of them were female. There was a significant difference between the two groups of caregivers (P < 0.05). The main caregivers of the elderly were partners. The proportion of disabled elderly living alone decreased while the proportion of depend on children and nannies increased. Except chronic disease management, establishment of electronic archives and health knowledge education, the proportion of elderly people receiving public health services for other projects was less than 50%. The proportion of disabled elderly people receiving on-site services, family sickbeds and medical assistance services was less than 50%, suggesting poor accessibility of basic medical care. The proportion of patients receiving pipeline care and pressure sore care service was less than 50%, which indicated the lack of special medical care for the elderly. Except for acute and chronic neck, shoulder, waist and leg pain, the proportion of receiving other rehabilitation services was less than 50%, suggesting a lack of professional rehabilitation. Conclusion Based on the investigation of the current situation of medical care for the aged at home in Hangzhou, it is found that there is a mismatch between supply and demand. It is suggested that the government encourage single persons to marry as much as possible to deal with the problem of life care for the aged in the future. It is also suggested that community service centers for the aged increase home service and short-term care services to enhance the living ability of the aged at home. It is suggested that community health service institutions improve the quality of public health services for the elderly, improve the accessibility of basic medical care, train specialized nurses for the elderly, and build professional rehabilitation departments.
- Community home care /
- Combination of medical care and maintenance /
- Investigation and study

HTML全文

表 1 居家养老人群生活照料情况[例(%)]

组别	人数	年龄 [M(P ₂₅, P ₇₅)，岁]	性别		主要生活照料人员
组别	人数	年龄 [M(P ₂₅, P ₇₅)，岁]	男性	女性	配偶	子女	保姆	独居
自理组	707	67(63, 72)	336(47.5)	371(52.5)	512(72.4)	104(14.7)	15(2.2)	76(10.7)
失能组	235	79(76, 83)	102(43.4)	133(56.6)	143(60.8)	54(23.1)	32(13.6)	6(2.5)
统计量		-17.635^a	1.204^b		70.909^b
P值		＜0.001	0.273		＜0.001
注：^a为Z值，^b为χ²值。

下载: 导出CSV

表 2 失能老年人的社区基本医疗需求现状及有效供给情况

项目	需求人数	有效供给人数	接受率(%)
常见病诊疗	86	64	74.4
现场救护	10	10	100.0
转诊服务	35	35	100.0
体检服务	235	228	97.0
中医药诊疗	65	65	100.0
家庭出诊	46	5	10.9
家庭病床	26	3	11.5
助医服务	110	23	20.9

下载: 导出CSV

表 3 失能老年人的医疗护理需求及有效供给情况

项目	需求人数	有效供给人数	接受率(%)
注射药物	34	30	88.2
呼吸道护理	12	10	83.3
管道护理	26	10	38.5
导尿	10	10	100.0
灌肠	8	5	62.5
压疮管理	21	5	23.8
常规检测	45	45	100.0

下载: 导出CSV

表 4 失能老年人的康复需求及有效供给情况

项目	需求人数	有效供给人数	接受率(%)
脑中风后遗症	18	4	22.2
骨折恢复期	10	3	30.0
急慢性颈肩腰腿痛	54	54	100.0
肢体功能障碍	12	4	33.3
吞咽功能障碍	32	2	6.3
康复器械使用	16	3	18.8
精神抚慰需求	15	5	33.3
认知功能康复	34	3	8.8

下载: 导出CSV

参考文献(19)

[1]	乔晓春. 养老产业为何兴旺不起来?[J]. 社会政策研究, 2019, 4(2): 7-21. https://www.cnki.com.cn/Article/CJFDTOTAL-SZYA201902004.htm
[2]	景天魁. 创建和发展社区综合养老服务体系[J]. 苏州大学学报(哲学社会科学版), 2015, 36(1): 29-33. https://www.cnki.com.cn/Article/CJFDTOTAL-SZDX201501006.htm
[3]	陈申, 崔焱, 郑静, 等. 养老机构与居家失能老年人日常生活活动需求未满足状况的差异性研究[J]. 中华护理杂志, 2019, 54(3): 434-438. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201903025.htm
[4]	朱恒鹏. "医养结合"的痛点在"医"不在"养"[J]. 中国财政, 2017(24): 36-38. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCE201724015.htm
[5]	王震. "医养结合"与"医养分开"[J]. 中国医疗保险, 2017, 10(10): 28. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBX201710011.htm
[6]	谢道溥, 费敏浩, 徐林山, 等. 杭州市医养护一体化服务破解老龄化难题[J]. 中国医疗保险, 2015, 8(11): 43-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBX201511021.htm
[7]	张文娟, 魏蒙. 中国老年人的失能水平和时间估计——基于合并数据的分析[J]. 人口研究, 2015, 39(5): 3-14. https://www.cnki.com.cn/Article/CJFDTOTAL-RKYZ201505001.htm
[8]	李莉, 裴瑞娟, 孙涛, 等. 社区卫生服务机构参与居家养老服务的供给侧改革探讨[J]. 中国卫生政策研究, 2016, 9(11): 52-56. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ201611009.htm
[9]	戴锦, 陈亚光, 高学义, 等. 以基层医疗机构为主导的社区医养结合模式研究[J]. 卫生经济研究, 2019, 36(7): 52-55, 66. https://www.cnki.com.cn/Article/CJFDTOTAL-WSJJ201907017.htm
[10]	周乐明, 吴开明, 许小兰, 等. 人口老龄化背景下重庆市社区开展医养结合的成效及探讨[J]. 现代医药卫生, 2018, 34(9): 1281-1284. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201809002.htm
[11]	LV Y B, ZHU P F, YIN Z X, et al. A U-shaped association between blood pressure and cognitive impairment in Chinese elderly[J]. J Am Med Dir Assoc, 2017, 18(2): e7-e13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294228/pdf/nihms840989.pdf
[12]	HOFFMAN G J, HAYS R D, WALLACE S P, et al. Receipt of caregiving and fall risk in US community-dwelling older adults[J]. Med Care, 2017, 55(4): 371-378. http://www.onacademic.com/detail/journal_1000039907236110_a264.html
[13]	CHEN C Y, GAN P, HOW C H. Approach to frailty in the elderly in primary care and the community[J]. Singapore Med J, 2018, 59(5): 240-245. http://www.onacademic.com/detail/journal_1000040475047910_2d07.html
[14]	SAITO J, HASEDA M, AMEMIYA A, et al. Community-based care for healthy ageing: Lessons from Japan[J]. Bull World Health Organ, 2019, 97(8): 570-574. http://www.researchgate.net/publication/334668716_Community-based_care_for_healthy_ageing_lessons_from_Japan/download
[15]	DE CONINCK L, BEKKERING G E, BOUCKAERTL, et al. Home- and community-based occupational therapy improves functioning in frail older people: A systematic review[J]. J Am Geriatr Soc, 2017, 65(8): 1863-1869. http://www.onacademic.com/detail/journal_1000039872223110_ee80.html
[16]	陈凌玉, 张玲芝, 郭晶. 杭州市某区老年人医养结合服务供需现状及影响因素分析[J]. 中华医院管理杂志, 2018, 34(6): 445-449.
[17]	李熹, 王芳, 袁莎莎, 等. 社区卫生服务中心参与医养结合服务现状研究[J]. 中国卫生政策研究, 2018, 11(11): 51-55. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ201811010.htm
[18]	徐筱婧媛, 王丽, 王美荣, 等. 北京市失能老人上门医疗服务评估指标体系的构建[J]. 中华全科医学, 2020, 18(1): 1-4, 14. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202001001.htm
[19]	陈颖, 马丽霞, 裴慧丽, 等. 不同失能程度老年人居家养老照护服务项目需求调查[J]. 中国实用神经疾病杂志, 2016, 19(1): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ201601019.htm