本文關鍵詞：我國預防接種服務現(xiàn)狀研究　出處：《山東大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 預防接種服務 整體滿意度 影響因素

【摘要】：研究背景預防接種服務是國家基本公共衛(wèi)生服務中的一項重要內容,是疾病預防控制工作的主要組成部分,其工作質量的高低直接關系到免疫規(guī)劃相關傳染病的預防和控制效果。近年來,我國預防接種服務工作取得了很大的進步,重大傳染病防治工作取得了明顯進展,但也存在一些問題,如部分兒童接種不及時甚至漏種、部分家長不重視、不信任預防接種等。因此,了解預防接種服務中存在的實際問題,對改進預防接種工作具有十分重要的意義。2015年,國家衛(wèi)生計生委疾控局委托國家衛(wèi)生計生委衛(wèi)生發(fā)展研究中心對國家基本公共衛(wèi)生服務項目中的疾控項目進行調查,本文從調查中篩選出有關預防接種服務的內容,對全國6個地區(qū)的預防接種服務情況進行研究。疫苗接種率及相關疾病防控情況是評價預防接種服務的重要指標,預防接種機構相關設施設備配備情況和基層醫(yī)務人員的素質是影響預防接種工作質量的重要指標,兒童預防接種服務情況及家長滿意度對發(fā)現(xiàn)預防接種服務工作存在的問題具有重要意義,本文將主要從上述幾個方面對我國預防接種服務工作進行研究。研究目的了解我國預防接種工作的現(xiàn)狀,包括當前疫苗接種情況及疾病防控情況、基層預防接種機構面臨的困難及挑戰(zhàn)、兒童接種情況及兒童家長滿意度等,發(fā)現(xiàn)當前我國預防接種服務工作存在的問題和小足,進而為提高預防接種服務水平提供政策建議。研究方法按照立意抽樣方法,根據(jù)行政區(qū)劃、地理分布與經濟發(fā)展水平,從全國選擇北京、廣東、湖北、吉林、云南、新疆6地作為調研省份,每個省份按GDP水平高、中、低各選擇一個縣。通過問卷、座談等方式對相關機構(衛(wèi)生計生行政部門、技術指導機構、社區(qū)衛(wèi)生服務中心/站、鄉(xiāng)鎮(zhèn)衛(wèi)生院、村衛(wèi)生室)和相關醫(yī)務人員進行調查。通過批質量保證抽樣法對預防接種服務情況及兒童家長滿意度開展入戶問卷調查,共調查1550人。利用EpiData3.02建立數(shù)據(jù)庫,利用Excel2013和SPSS20.0對數(shù)據(jù)進行整理和統(tǒng)計分析,計數(shù)資料的統(tǒng)計描述用率或構成比表示,不同組間的率或構成比的比較用χ2檢驗,不同組間均值的比較用t檢驗或方差分析,采用Logistic回歸對兒童漏種或未接種的影響因素及兒童家長預防接種整體滿意度的影響因素進行分析。研究結果1.新生兒首劑乙肝疫苗及時接種率有波動,新疆2014年較2013年降低了5.35個百分點,廣東省和湖北省在2014年也出現(xiàn)略有下降的情況;6省的兒童乙肝疫苗全程接種率自2012年開始均達到99%以上;6省的含麻疹成分疫苗第二劑次接種率2013年以來均達到99%以上。除云南外,各地乙肝發(fā)病率均有了大幅下降,但廣東省、湖北省和新疆地區(qū)乙肝發(fā)病率仍然高達146.81/10萬、104.91/10萬、166.62/10萬;近年來麻疹發(fā)病率呈現(xiàn)出抬頭的趨勢,網(wǎng)絡報告病例數(shù)大幅增加,特別是2014年北京市和吉林省麻疹發(fā)病率快速攀升均超過了11/10萬;2014年各省的疑似預防接種異常反應調查診斷分類率均較2009年取得了很大進步,特別是云南省由2009年的88.60%提高到了 99.58%。2.本次調查的34個機構,82.35%是規(guī)范門診;平均每個機構的接種房屋面積為87.22 m2,其中吉林平均每個機構接種面積最大,為120 m2,最低的是云南,為60.5m2。平均每個機構擁有4.06個冰箱,1.18個冰柜,9.35個冷藏包。3.各地從事預防接種工作的醫(yī)務人員以女性為主,占82.25%;年齡26-45歲占71.02%;崗位方面,醫(yī)生占33.33%,護士占41.67%,公共衛(wèi)生占14.49%,其他占10.51%;65.94%的人是初級職稱或無職稱;學歷以�？茖W歷為主,占43.84%;54.35%的人月平均收入3000元及以下;6地只從事預防接種服務的醫(yī)務人員占20.65%,從事6種及以上公共衛(wèi)生服務的占37.68%;有18.48%的醫(yī)務人員明確表示上級專業(yè)技術指導機構對基層醫(yī)療機構人員的指導不足;15.22%的工作人員對承擔服務的積極性評價比較低甚至有一定的抵觸情緒。4.接受調查的適齡接種兒童建證率為98.97%,建卡率為98.52%,卡證相符合的達到97.81%。6個調研地點建證率、建卡率、卡證符合率均在95%以上,其中湖北省的建證率、建卡率、卡證符合率均最低。5.6地有184名適齡接種兒童有漏種或未接種的情況,占總人數(shù)的11.87%,其中新疆地區(qū)適齡接種兒童漏種或未接種比例最高,漏種或未接種比例為19.02%;卡方檢驗結果顯示,被調查家長的年齡、學歷、職業(yè)、調查地類型、是否有預防接種證、是否有預防接種卡是影響2-6歲適齡接種兒童漏種或未接種的因素;多因素分析結果顯示,被調查家長的年齡、職業(yè)、是否有預防接種證、是否有預防接種卡是影響2-6歲適齡接種兒童漏種或未接種的因素。6.從6個調研地來看,新疆地區(qū)家長對接種的滿意度相對較高,湖北相對較低;從各個條目來看,滿意度最高的是整體滿意度,得分為(4.26±0.52),得分最低的是家到接種門診的距離(4.13±0.61)和疫苗接種情況介紹滿意度(4.13±0.63)。從城鄉(xiāng)來看,鄉(xiāng)鎮(zhèn)地區(qū)家長的整體滿意度高于城鎮(zhèn)地區(qū)。單因素分析結果顯示,被調查家長與兒童的關系、戶籍、通知預防接種的方式、等候時間、步行到預防接種門診的時間、醫(yī)務人員是否告知注意事項6個因素是影響家長預防接種整體滿意度的因素。多因素分析結果顯示,等待時間、醫(yī)務人員是否告知注意事項是影響家長預防接種服務整體滿意度的因素。政策建議:1.多項措施并舉減少疫苗漏種現(xiàn)象,進一步提高疫苗接種率。2.進一步發(fā)揮專業(yè)機構的指導作用。3.進一步提升基層服務能力。4.加強免疫規(guī)劃疫苗及冷鏈設備的使用管理工作,保證疫苗質量。5.加快預防接種信息化建設和管理。6.加大預防接種服務的宣傳力度。
[Abstract]:The research background of immunization services is an important content of basic public health services in the country, is the main part of the work of disease prevention and control, prevention and control effect is directly related to immunization related infectious diseases of the quality of its work. In recent years, China's pre vaccination service work has made great progress, work the prevention and control of major infectious diseases has made significant progress, but there are also some problems, such as part of vaccination of children is not timely or even missing, some parents do not pay attention, do not trust the vaccination. Therefore, to understand the actual problems of vaccination services, is very important for the improvement of the vaccination work has significance for.2015 years, the national health plan the Commission for Disease Control Commission of health development research center on the livelihood of national basic public health service project commissioned by the National Health Bureau disease control project survey, this paper from the survey screen Select the relevant vaccination service content of vaccination services in 6 areas of the country. The prevention and control of related diseases and vaccination rate is an important index to evaluate the quality of vaccination service, preventive vaccination institutions equipped with related facilities and equipment and grassroots medical staff is an important index affecting the quality of immunization of children. Vaccination service and satisfaction of parents is very important for prevention of existing immunization services work, this article mainly from the aspects of China's prevention research vaccination service work. Objectives: to understand the status quo of China's vaccination work, including the current situation of prevention and control of vaccination and disease, primary prevention difficulties and challenge inoculation facing the organization, vaccination of children and parents satisfaction, found that China's current vaccination service work The existing problems and the small foot, so as to improve the vaccination service level to provide policy recommendations. Research methods in accordance with the purposive sampling method, according to the administrative division, geographical distribution and the level of economic development, from the choice of Beijing, Guangdong, Hubei, Jilin, Yunnan, Xinjiang 6 provinces as the research, according to the high level of GDP in each. Low provinces, each choose a county. Through the questionnaire, discussion on relevant institutions (health administrative departments, technical guidance institutions, community health service center / station, township hospitals, village health room) were investigated and related medical staff. Through a lot quality assurance sampling method to carry out questionnaire survey on prevention vaccination service and satisfaction of parents of children, a total of 1550 people were investigated. Using EpiData3.02 database, the data were analyzed by Excel2013 and SPSS20.0, enumeration data described by rate or composition More than that, among different groups or percentages of the 2 test was used to compare between different groups, compared with the mean t test or analysis of variance, influence by Logistic regression on children missing or unvaccinated factors and parents of children vaccination overall satisfaction analysis. The results of 1. newborn first dose of hepatitis B vaccine timely vaccination rate fluctuations, Xinjiang in 2014 5.35 percentage points lower than in 2013, Guangdong province and Hubei province have declined slightly in 2014; the whole course vaccination rate of hepatitis B vaccine in children 6, since the beginning of 2012 reached 99% to 6; the province contains second doses of measles containing vaccine since vaccination rate in 2013 of more than 99%. In addition to Yunnan, around the incidence of hepatitis B were dropped, but the Guangdong Province, Hubei province and the incidence of hepatitis B in Xinjiang area rate is still as high as 146.81/10 million, 104.91/10 million, 166.62/10 million in recent years; The incidence rate of measles showed a rising trend of network, the number of reported cases increased significantly, especially in 2014, Beijing city in Jilin province and the incidence of measles in the rapid rise of more than 11/10 million; in 2014 the suspected abnormal reaction to vaccination survey diagnostic classification rate than in 2009 has made great progress, especially in Yunnan province increased from 88.60% in 2009 the 34 99.58%.2. in this survey, 82.35% standard outpatient; average institutions vaccination housing area is 87.22 m2, of which Jilin average institutions inoculated with the largest area, 120 m2, Yunnan is the lowest, 60.5m2. average institutions have 4.06 refrigerators, 1.18 freezers, 9.35 refrigerator.3. all engaged in the vaccination work of medical personnel in female dominated, accounting for 82.25%; aged 26-45 years old accounted for 71.02% jobs, accounting for 33.33%; the doctor, public health nurses accounted for 41.67%, accounting for 14.49%, other Accounted for 10.51%; the primary title or title 65.94% people; education to college education, accounting for 43.84%; 54.35% of the average monthly income of 3000 yuan and below 6; only engaged in immunization service medical personnel accounted for 20.65%, 6 or more engaged in public health services accounted for 37.68%; 18.48% of the medical staff clear said the guidance of higher professional and technical guidance to staff basic medical institutions; 15.22% staff on the positive evaluation of bear services is relatively low and even some resentment.4. survey of school-age children vaccinated building card rate is 98.97%, the record rate is 98.52%, the cards reached 97.81%.6 research sites building card rate, rate card consistent with the certificate card, the coincidence rate is above 95%, the Hubei province building card rate cards, card rate, coincidence rate was the lowest.5.6 of 184 school-age children vaccinated or unvaccinated leakage situation, the total people The number of 11.87%, the Xinjiang area of school-age children vaccinated or unvaccinated the highest proportion of leakage or leakage, no vaccination rate was 19.02%; chi square test results show that the surveyed parents age, education, occupation, investigation type, whether vaccination certificate, whether there is a card is the influence factors of prevention at the age of 2-6 school-age children vaccinated or unvaccinated leakage; multi factor analysis showed that the surveyed parents age, occupation, whether vaccination certificate, whether vaccination card is 2-6 year old age children vaccinated or unvaccinated.6. leakage factors from 6 research, Xinjiang area parents' satisfaction to inoculation Hubei is relatively high, relatively low; from the entry point of view, is the highest satisfaction overall satisfaction score was (4.26 + 0.52), the lowest score is the home to the vaccination clinic distance (4.13 + 0.61) and vaccination satisfaction (4.13 introduction 0.63). From the view of urban and rural areas of the township, the overall satisfaction of parents is higher than that in urban areas. The single factor analysis showed that the relationship between parents and children in the household registration, investigation, notice of vaccination, waiting time, walk to vaccination clinics, medical staff advise whether note 6 factors are the influence factors of parents the overall satisfaction of vaccination. The results of multivariate analysis showed that the waiting time, inform the medical staff whether precautions are the influence factors of parents satisfaction. Preventive vaccination service policy recommendations: 1. measures simultaneously to reduce the leakage phenomenon of the vaccine, to further improve the vaccination rate of.2. to further play the guiding role of.3. professional organizations to further enhance the ability of grassroots service.4. strengthen the EPI vaccine and the use of cold chain equipment management, ensure the quality of the vaccine inoculation of.5. to accelerate the construction of information and Prevention Manage.6. to increase the publicity of vaccination services.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R186

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