Study On The Practicing Ability And Coping Status Of Pediatric And Obstetric Medical Staff In Three County-Level Medical Institutions In Yunnan Province Under The "Two-Child" Policy

Objective:Under the background of "two-children" policy for the supplier health service institutions in Yunnan province medical staff to carry out the investigation and research,through the investigation and understanding of department of gynaecology and obstetrics,pediatrics and child health care department and related departments of medical workers in clinical skills,scientific research and communication skills,master basic specialized technology to the medical personnel evaluation and research related to medical and health institutions to cope with the challenge of "two-children" policy of medical services provided by the situation,and to the health service utilization of patients satisfaction and demand research,discusses the problems existing in the medical service and management and the weak link,to better meet the needs of the masses and provide quality health services to provide decision-making basis.Methods:Referring the average birth rate of 12.88‰ in Yunnan as the selection criteria,11 medical and health institutions in 3 cities in the C city with a higher birth rate of 13.83‰ and a lower birth rate of 9.3‰ in Yunnan Province were selected.Using a cross-sectional survey methodology,a combination of quantitative and qualitative research was conducted to investigate medical staff and patients in the gynaecology,obstetrics,pediatric and child health departments of general hospitals and maternal and child health hospitals,using self-designed medical staff and patients.Questionnaire was used as a survey tool,and the data collected by Epidata 3.1 was used to analyze the data collected by SPSS 19.0 statistical software.The comparison between different rates was performed by 2 test.The influencing factors were analyzed by multivariate logistic regression analysis.The test level was ?=0.05.Results:1.The basic results of the survey:A total of 1015 valid questionnaires were obtained in this survey(the total questionnaire was 1022,and the recovery rate was 99.3%).A total of 321 medical staff were surveyed in 3 cities,and 694 were treated.Among them,101 were medical staff in A city and 190 were hospitalized;151 were medical staff in B city,233 were in hospital;69 were medical staff in C city There were 272 patients.Medical staff 13 males(4%),female 308(96%);gynecology 99(30.8%),obstetrics 102(31.8%),pediatrics112(34.9%),children's health department 8(2.5%)21;management positions 21(6.5%),professional and technical positions 300(93.5%),average age(32.96±10.47)years;151(21.7%)males,543(78.3%)females,average age 34 years old(34.51±22.219).2.The medical personnel do not fully master the professional skills.102 medical staff in the obstetrics department "can be skilled in the common childbirth and puerperal complications".The general situation is(average 6.2 points),and the 11 common medical staff are more proficient in 6 items such as postpartum hemorrhage(9.5 points).5 cases of uterine rupture and uterine rupture(5.9 points)are weak;12 cases of pathological pregnancy(average 8.9 points)can be treated,most people have premature rupture of membranes(9.2 points),premature delivery(8.9 points)2 items,10 items such as hypertensive disorder complicating pregnancy(8.8 points),polyhydramnios or oligohydramnios(8.5 points)are weak;most of the 15 common obstetric technical practices(average score 6.8)are mastered.The mid-late pregnancy examination method(obstetric four-step palpation method,listening to fetal heart method)(9.6 points)and other 8 items are better,and the breech vaginal midwifery(6.3 points)and other 7 items are poorly mastered.For the gynecology 99 medical staff common technical operation specifications proficiency and operation(average score of 6.2 points)to investigate,10 common operating technical specifications for colposcopy(8.0 points)and other four mastery,vestibular gland abscess Incision(5.9 points)and other four items are generally mastered.A total of 112 pediatric medical staff were familiar with the common treatment of neonatal diseases(average 7.8 points).Most of the 8 common neonatal diseases were mastered with red buttocks(9.5 points)and 6 were well mastered.Membrane disease(4.4 points)and premature infants(6.5 points)are relatively weak;most of the 12 pediatric common operational skills can only master 2 items(average score of 3.70 points),except for artificial respiration(7.4 points)and ECG Operational routine(6.1 points)This type of very basic medical routine operation is well mastered,and the remaining 4 lumbar punctures(3.4 points)are poorly mastered.3.Since the implementation of the two-child policy,the total number of hospital patients,outpatients,the actual bed utilization rate and the number of obstetric and maternal prenatal examinations have increased.From 2015 to 2016,the number of maternal prenatal inspections in A/B/G city has increased by an average of 16%?45%?30.1%.The workload of medical staff has increased.(?2=25.958,P<0.004).Pressure comes from patients' pressure:the patient's condition changes rapidly(68.5%),the patient is not cooperative,and the work burden is increased(67.7%);Pressure from patients' family members and relatives:relatives' requirements,high expectations,excessive rights protection(85.7%),relatives' cultural quality and medical knowledge level(57.0%),relatives' opinion that medical expenses are too high(44.5%);Pressure from professionals:Interpersonal conflict stress(72.3%),high demand brought about by the specialist skills,working pressure(63.2%),medical care,accident harm to bring(59.2%),the pressure of heavy work load(58.9%),low risks,treatment(55.8%)and length of time(29.6%),work and family conflicts(29.3%),education level high(24.3%),poor working environment(23.4%),different department staff pressure source,The pressure in gynecology mainly comes from the high requirements of educational level and heavy workload(?2=8.112,P<0.044;?2=9.511,P<0.023);Obstetric pressure mainly comes from the rapid change of patients' conditions,high risk of work and low pay(?2=12.710,P<0.005;?2=26.625,P<0.000);Paediatrics believe that stress mainly comes from poor work environment,sometimes work and family life conflicts(?2=16.921,P<0.001;?2=11.230,P<0.011);The pressure in the health care department comes from the fact that compared to the fixed working hours,the increase in the number of children's physical examinations leads to the long working hours and no change in the salary(?2=8.876,P<0.031).4.Since the implementation of the " Two-children " policy,313 people(97.5%)have participated in the department's study and training,and 137(47.8%)have participated in the monthly training,and 74 people(23.6)per month 2-3 times.%).The main form of study is 222(69.2%),130(41.5%)and 115(49.5%).The main content of the study included the diagnosis and treatment of common diseases of women and children(78.3%),prenatal screening(60.1%),family planning technical services(58.5%),neonatal disease screening(52.7%)and midwifery technical services(50.2%)..The departments of the investigation have increased the irregular training of medical staff after the policy facilities,but the management assessment system still follows the provisions before the implementation of the policy.5.Among the patients,148(21.3%)were satisfied with the hospital service,372(53.6%)were satisfied,136(19.6%)were not satisfied,36(5.2%)were not satisfied,and 2(0.3%)were not satisfied.The results of multiple Logistic regression analysis showed that only two variables,education level(?2=108.317,P<0.01)and personal monthly income(?2=93.637,P<0.01),had an impact on the evaluation satisfaction of patients.The significant factors influencing the satisfaction evaluation were the medical skill level of the patients(OR=0.028,95%CI:0.270-1.560)and the facility environment in the treatment area of the hospital(OR=0.024,95%CI:1.044-1,840).The patients are satisfied with respecting and protecting patients' personal privacy,and satisfied with doctors' medical technology and service attitude.Relatively unsatisfied is the service attitude of some auxiliary departments in the diagnosis and treatment process(b-ultrasound room,imaging department);At the same time,the patients' satisfaction with the environment of the hospital treatment area,the outdoor environment and the outpatient procedure is somewhat deficient.But the most unsatisfactory is the patient to the hospital complaint channel is not unobstructed.Conclusion:Since the implementation of the " two-children”policy,the number of medical institutions has been increasing,the workload and pressure of medical staff have increased,some medical staff are young,the titles are low,and the clinical experience is insufficient.In particular,the clinical practice levels of obstetrics and pediatricians are uneven.While improving medical and human resources,we should also improve the clinical common operational skills,scientific research capabilities and communication skills of obstetric pediatric medical staff,pay attention to the changes in the attitudes of the patients,and provide quality medical services from the perspective of patients to improve the competitiveness of hospitals.And better respond to the challenges brought about by policy changes.