Page 7 - 中国全科医学2022-13

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Creation and Utilization of the Health Records in Residents：a Demand-side Survey in Three Eastern，Central and
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Western Chinese Provinces JIANG Zhongshi，YOU Lili ，YANG Siqi，FAN Zixuan，LIU Yuanli
School of Health Policy and Management，Chinese Academy of Medical Sciences & Peking Union Medical College，Beijing
100730，China
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Corresponding author：YOU Lili，Associate professor，Master supervisor；E-mail：youlily_pumc@163.com
【Abstract】 Background The creation of health records for Chinese residents is a key task for deepening the reform
of the pharmaceutical and healthcare system，and an important action for promoting the equity of essential public health services.
However，domestic studies on resident health records are mainly using the data from a city or community，and those using the
national data from a demand-side perspective are rather scarce. Objective To understand the creation and utilization of health
records in Chinese residents. Methods From November to December 2019，multistage sampling was used to select three
provinces/municipality（Zhejiang，Shanxi and Chongqing） from eastern，central and western China（one was extracted from
each geographical region），then from each of them，one urban district and one county were extracted. Randomly selected 2
community health centers/stations，township health centers/village clinics in the corresponding districts（counties）. Finally，
20 community health service centers/township health centers were selected，the visitors of these institutions were invited to attend
a questionnaire survey for understanding their information about the creation of health records，and the access to the health
records，as well as satisfaction with the services. For ease of analysis，the visitors were classified into six categories（0-6-year-
olds，pregnant women，over 65-year-olds，hypertensioners，diabetics，and general population） in accordance with the
population groups defined in the Essential Public Health Service Programs. Results Altogether，10 067 residents were included
for final analysis. Among them，9 119（90.58%） self-reported that they had received health records creation services. The
rates of creation of health records in 0-6-year-olds，pregnant women，over 65-year-olds without hypertension/diabetes，over
65-year-olds with hypertension，under 65-year-olds with hypertension，over 65-year-olds with diabetes，and under 65-year-
olds with diabetes，as well as general population were 94.09%（2 787/2 962），95.60%（956/1 000），87.87%（616/701），
88.87%（1 414/1 591），92.91%（747/804），89.41%（895/1 001），92.72%（471/508），and 82.20%（1 233/1 500），
respectively. Among those with health records created，67.02%（5 990 / 8 938） could access to their health records at any time，and
the health records accessed by most of them were printed〔75.76%（4 538/5 990）〕. However，12.40%（1 108/8 938）of residents
reported that they had no access to their health records，and other 20.59%（1 840/8 938）indicated that they had never tried to gain
access to their health records. The rate of satisfaction with health records services in residents was 83.31%（4 352/5 224）. The rate of
health records creation and rate of accessing the health records differed significantly by province，district or country，household monthly
income per person，education level，and category of population（P<0.05）. The rates of satisfaction with the creation of and access to
health records differed significantly by province，type of visited health institution，district or country，household monthly income per
person，education level，and category of population（P<0.05）. Conclusion Generally，the rate of creation of health records in
Chinese residents has significantly increased. The rate of utilization of the records has also enhanced，but needs further improvement.
Moreover，residentssatisfaction with health records services may be at a moderate level.
【Key words】 Health records，personal；Primary health care institution；Establishment rate；Health care rationing；
Services utilization

居民健康档案是医疗卫生机构为城乡居民提供医 康档案的研究更多局限在某个城市或社区内，在全
疗卫生服务过程中的规范记录，是以居民个人健康 国范围内从需方角度开展跨省份比较的研究相对缺
为核心、贯穿整个生命过程、涵盖各种健康相关因 乏。因此，本研究基于 2020 年这一关键时间点，对
素的系统化文件记录 ［1］ 。居民健康档案是居民享有 我国不同省份的居民健康档案落实情况进行横向检
均等化公共卫生服务的重要体现，是医疗卫生机构 验和比较，以评估我国健康档案发展的阶段性成果，
为居民提供高质量医疗卫生服务的有效工具，是各 这对进一步改善医药卫生服务、促进基本公共卫生
级政府及卫生行政部门制定卫生政策的参考依据 ［2］ 。 服务均等化提供具有重要意义。
在《卫生部关于规范城乡居民健康档案管理的指导 1 对象与方法
意见》（卫妇社发〔2009〕113 号）中，也提出明确 1.1 研究对象 于 2019 年 11—12 月，采用多阶段
的工作目标：“到 2020 年，初步建立起覆盖城乡居 分层抽样的方法选定研究对象，具体抽样方法为：
民的，符合基层实际的，统一、科学、规范的健康 在我国东、中、西部各选择 1 个省份开展“国家基
档案建立、使用和管理制度”。目前，我国关于健 本公共卫生服务十年评估需方调查”，分别为浙江