关键词: 社区卫生服务, 中医适宜技术, 应用现状, 对策, 上海

Abstract: Objective　To investigate the popularization of appropriate Traditional Chinese Medicine（TCM） techniques in Shanghai primary community health service centers（PCHS），and further analyze the advantages，problems and corresponding strategy.Methods　A total of 49 PCHS were selected from 2 to 4 PCHS in each of 16 districts（couties） of Shanghai by means of purposive sampling method.Based on TCM policies in Shanghai and China，the self-designed questionnaire，including the application of appropriate TCM techniques in Shanghai PCHS in 2016，the number of projects carried out，the number of TCM doctors，the number of non-TCM doctors，departments that can operate the technique，and the number of patients served，was used for the survey during September to November 2017，and　chargers of each center filled the questionnaire.A total of 49 questionnaires were issued，and 48 questionnaires were recovered，with 98.0% of recovery rate.Results　Among 4 appropriate TCM technique projects in Shanghai PCHS in 2016，the average number of applied project was（8.17±4.33），the median number of service person was 1 914.5（5 420）.Projects with higher promotion rate were massage treatment for acute lumbar sprain，massage treatment for stiff neck，electric acupuncture treatment for lumbar disc herniation，nape eight-needle therapy for prevention and treatment of cervical spondylosis，electric needle shallow puncture treatment for facial paralysis，all>70%.Projects with low promotion rate were vitamin K3 Sanyinjiao acupoint injection　for pelvic pain，epiglottis cartilage pushing for infantile vomiting，and auricular vein acupotomy　treatment for facial planar wart，all <10%.Items operated by physicians most were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis，which were 3.31 and 2.85，respectively.Items operated by few physicians were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting，which were 0.02 and 0.08，respectively.Items operated by most departments were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis，which were 1.58 and 1.46，respectively.Items operated by few departments were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting，which were both 0.02.Items with most average service times were electroacupuncture treatment of lumbar disc herniation and the prevention and treatment of chronic respiratory diseases with acupoint application in communities，which were 1 081 and 727，respectively.Vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting had no visit.Nine out of ten　categories，including 95 items in promotion of TCM techniques during the 13th Five-year Plan has been carried out in Shanghai PCHS，excluding anorectal category.Forty-eight PCHS carried out（13.29±9.23） techniques on average，with 18 904.5
（45 410.0） median service person-time.Acupuncture and compress and fumigation were used by physicians most，which were 21.08 and 10.88，respectively.The average number of operating physicians in the category of minimally invasive TCM and other items were less，with 0.29 and 1.44，respectively.Acupuncture and compress and fumigation were used the most by departments，which were 10.71 and 4.33 on average，respectively，and technique applied by few departments was minimally invasive treatment in TCM，with 0.25 on average.Conclusion　Shanghai PCHS has made progress in popularizing appropriate TCM techniques.However，there are differences in application among different districts（couties） and PCHS.The suggestions are to improve charging items and standards，select new TCM projects and strengthen the long-term training and publicity of appropriate TCM techniques.

Key words: Community health services, Appropriate traditional Chinese medicine techniques, Application status, Countermeasures, Shanghai