基于地理信息系统技术的区域社区中医康复服务需求变化趋势研究

背景　中医在社区康复的发展中发挥着重要作用。相比于传统分析方法，地理信息系统（GIS）技术在分析区域中医康复服务需求趋势变化方面具有独特优势。目的　通过盘点区域社区中医康复服务需求的变化趋势，为社区中医康复服务建设提供指导。方法　2017年7—8月，以上海市黄浦区10家社区卫生服务中心为研究对象，对社区中医康复服务的历史需求变化趋势进行研究。采用机构调研问卷收集（1）2015—2017年6月社区正在开展或曾经开展的中医康复服务内容；（2）2015—2017年6月社区中医康复服务的门诊量；（3）2015—2017年6月社区中医康复服务的诊疗费。2017年全年门诊量与诊疗费的数据预测：2017年上半年（截至6月份）的相关数据×2。采用帕累托法则，根据2017年全年门诊量（预测）数据，对社区中医康复服务内容进行分类。采用ArcGIS 10.5.1（试用版）进行区域中医诊疗方案空间分布可视化展示。结果　社区中医康复服务共有29项，主要需求服务有3项，一般需求服务有26项。2015—2017年，区域社区中医康复服务总门诊量从109.8万人次逐年下降至97.8万人次，诊疗费从2 068.4万元逐年上升至2 188.6万元。以穴位敷贴和红外线为代表的主要需求服务的门诊量占总门诊量比重由88.3%逐年下降至82.9%，诊疗费占总诊疗费比重由88.0%逐年下降至79.7%。相对地，以中药定向透入和针灸为代表的一般需求服务的门诊量与诊疗费占总体的比重逐年上升。主要需求服务门诊量在黄浦区中部社区呈上升趋势，而在东部和西部社区呈下降趋势；一般需求服务门诊量在中部和西部社区呈上升趋势，而在东部社区呈下降趋势。结论　社区居民对社区中医康复服务的需求总体呈上升趋势，需求结构呈现多样化趋势。社区居民对穴位敷贴和红外线等服务项目的整体需求呈萎缩态势，而对中药定向透入和针灸类服务的整体需求处于快速增长阶段。社区应顺应居民的需求变化趋势，建设相应的中医康复特色科室。

Trend of Traditional Chinese Medicine Rehabilitation Service Demand in Regional Communities Based on Geographic Information System Technology

Background　Traditional Chinese Medicine（TCM） plays an important role in the development of rehabilitation services in communities.Geographic Information System（GIS） technology has unique advantages in analyzing trends of demand for TCM rehabilitation services in regional communities compared with other traditional analytical methods.Objective　To provide guidance for the development of TCM rehabilitation services in the community by analyzing demand trends of TCM rehabilitation services in regional community health service centers.Methods　Ten Community health service centers（CHSC） in Huangpu District，Shanghai were selected from July to August 2017 as research subjects to study the trend of historical demand for community rehabilitation services of TCM.Questionnaires were used to collect （1） TCM rehabilitation services being or ever being carried out in the community from 2015 to June 2017；（2） the outpatient volume of TCM rehabilitation services in the community from 2015 to June 2017；（3） the expense of diagnosis and treatment of TCM rehabilitation services in the community from 2015 to June 2017.The data forecast of outpatient service volume and treatment expense in 2017：the related data in the first half of 2017 （up to June）×2.According to Pareto Principle，the types of community TCM rehabilitation services were classified according to annual outpatient volume（forecast） in 2017.ArcGIS 10.5.1（trial version） was used to visualize the spatial distribution of regional TCM diagnosis and treatment programs.Results　There were 29 community TCM rehabilitation services，including 3 services with major demand and 26 services with general demand.From 2015 to 2017，the total outpatient volume of TCM rehabilitation services in regional communities declined from 1.10 million person-times to 0.98 million person-times annually，but its total medical expense increased from 20.68 million yuan to 21.89 million yuan annually.The proportion of outpatient services with major demand represented by acupoint application and infrared radiation declined from 88.3% to 82.9% annually，and the proportion of its expense in total diagnosis and treatment expense decreased from 88.0% to 79.7% annually.In contrast，the proportion of outpatient services with general demand represented by TCM directional penetration and acupuncture and its expense increased year by year.There was an upward trend of outpatient volume of services with major demand at CHSC in the central part of Huangpu District，but a downward trend showed in the eastern and western part of Huangpu District.There was an upward trend of outpatient volume of services with general demand at CHSC in the western and central part of Huangpu District，but a downward trend occurred in the eastern part of Huangpu District.Conclusion　The demand of community TCM rehabilitation services was generally on the rise，and the demand structure is diverse.The demand for acupoint application and infrared radiation showed a declining trend，while the demand for TCM directional penetration and acupuncture were in a rapid growth.The construction of departments with TCM rehabilitation characteristics should adapt to the changing needs of residents.