摘要：
Objective To investigate and evaluate the comprehensive ability and current situation of health care services for climacteric women of medical institutions in Sichuan Province,so as to provide guidance for further improvement of health care services for climacteric women.Methods A total of 193 physicians who attended the continuing medical education projects held by West China Second University Hospital,Sichuan University and Sichuan Provincial Hospital for Women and Children from November 2016 to June 2017,and 121 hospitals where all of these 193 physicians worked at were selected as research subjects.The self-designed Climacteric Health Care Service Medical Staff and Medical Institutions Questionnaire was used to collect the basic information of physicians and hospitals,the development of climacteric health care services in hospitals,and the physicians' relative knowledge about climacteric health care services.And the results of questionnaires were analyzed statistically.The proportions of climacteric clinics,full-time and skilled medical staff engaged in climacteric health care services,establishment of health records for climacteric women,regular follow-up visits to climacteric women,applying hormone replacement therapy (HRT) as the conventional treatment method for climacteric syndrome among hospitals with different qualities,in different regions,cities and levels were compared by chi-square test,respectively.Results ①Among the 193 physicians in this research,the average age was (40.9 ± 8.8) years old.And physicians with bachelor degree or above accounted for 70.5％ (136/193),with intermediate professional title accounted for 79.8 ％ (154/193),obstetrics and gynecologists accounted for 58.0％ (112/193).②Among the 121 hospitals in this research,70 hospitals did not apply HRT as the conventional treatment method for climacteric syndrome which accounting for 57.9 ％ (70/121).And 36 hospitals set up climacteric clinics which accounting for 29.8％ (36/121),25 hospitals equipped with full-time and skilled medical staff for climacteric health care service which accounting for 20.7％ (25/121),29 hospitals established health records for climacteric women which accounting for 24.0％ (29/121),and 29 hospitals provided regular follow-up visits to climacteric women which accounting for 24.0％ (29/121).③In this research,the proportions of specialized hospitals with climacteric clinic,equipment of full-time and skilled medical staff for climacteric health care services,establishment of health records for climacteric women,and providing regular follow-up visits to climacteric women were 45.6％ (26/57),36.8％ (21/57),33.3％ (19/57) and 33.3％ (19/57),respectively,which all were higher than those of general hospitals 15.6％ (10/64),6.3％ (4/64),15.6 ％ (10/64) and 15.6 ％ (10/64),respectively,and all the differences were statistically significant (x2 =12.973,P＜0.001;x2=17.213,P＜0.001;x2 =5.188,P=0.023;x2 =5.188,P=0.023).There was statistical difference in the proportions of providing regular follow-up visits to climacteric women among hospitals in different regions (x2 =9.077,P=0.028).And the proportion of hospitals providing regular follow-up visits to climacteric women in eastern Sichuan Province ranked the first which was 54.5％ (6/11),and hospitals in western Sichuan Province ranked the second which was 25.9％ (15/58).There were statistical differences in the proportions of setting up climacteric clinics and applying HRT as the conventional treatment method for climacteric syndrome among hospitals with different levels,respectively (x2 =10.199,P =0.006;x2 =7.694,P=0.021).And proportions of setting up climacteric clinics and applying HRT as the conventional treatment method for climacteric syndrome of tertiary hospitals both were the highest among hospitals with different levels which were 44.7％ (21/47) and 55.3％ (26/47),respectively.(④Among the 193 physicians in this research,99.0％ (191/193) of them thought that it was necessary to set up climacteric clinic,42％ (81/193) of them did not know the diagnostic criteria of climacteric symptoms and symptoms related to menopause,69.9％ (135/193) of them did not use the diagnostic criteria of climacteric syndrome and symptoms related to menopause when providing climacteric health care services,80.9 ％ (169/193) of them knew HRT but considered that individual HRT treatment was difficult,and 1.6％ (3/193) even did not know HRT.And 71.0％ (137/193) of them got to know HRT through literature.Conclusions The constructions of climacteric clinics in medical institutions at different levels in Siehuan Province are insufficient obviously.The basic theoretical knowledge of climacteric health care is scarce.Medical institutions at different levels should raise the awareness of the importance of climacteric health care,and strengthen the health education,relevant facilities and equipment construction,meanwhile,reinforce the construction and management of climacteric clinic,to improve the comprehensive service level of climacteric health care services.%目的 调查和评价四川省各级医疗机构对更年期妇女的保健服务综合能力及其现状,为进一步改善和提高更年期妇女的保健服务提供参考依据.方法 选择2016年11月至2017年6月,参加四川大学华西二医院、四川省妇幼保健院举办的国家级继续医学教育项目的193位医务人员,以及其所在的121家医院为研究对象.采用自行设计的《更年期妇女保健服务人员及机构调查问卷表》,对被调查医务人员的基本信息、被调查医院的基本情况与更年期妇女保健服务的开展情况,以及被调查医务人员对更年期妇女保健相关知识的掌握情况进行调查,并对调查结果进行统计学分析.采用x2检验,对不同性质、地区、城区、等级医院开设女性更年期门诊、有专职人员从事更年期妇女保健工作、对更年期妇女建立健康档案及进行定期随诊、门诊常规应用激素替代疗法(HRT)治疗更年期综合征的比例进行比较.结果 ①本研究193位接受调查医务人员的平均年龄为(40.9±8.8)岁,本科及以上学历占70.5％(136/193),中级职称所占比例为79.8％(154/193),妇产科医师所占比例为58.0％(112/193).②本研究涉及的121家医院中,70家(57.9％,70/121)医院门诊未常规应用HRT治疗更年期综合征,36家(29.8％,36/121)医院开设女性更年期门诊,25家(20.7％,25/121)医院有专职人员从事更年期妇女保健工作,29家(24.0％,29/121)医院对更年期妇女建立健康档案,29家(24.0％,29/121)医院对更年期妇女进行定期随诊.③本调查结果显示,专科医院开设女性更年期门诊、有专职人员从事更年期妇女保健工作,以及对其建立健康档案、进行定期随诊的比例分别为45.6％(26/57)、36.8％(21/57)、33.3％(19/57)、33.3％(19/57),均分别高于综合性医院的15.6％(10/64)、6.3％(4/64)、15.6％(10/64)、15.6％(10/64),二者比较,差异均有统计学意义(x2=12.973,P＜0.001;x2=17.213,P＜0.001;x2 =5.188,P=0.023;x2 =5.188,P=0.023).不同地区医院对更年期妇女进行定期随诊的比例比较,差异有统计学意义(x2=9.077,P=0.028).其中,四川省东部地区医院对更年期妇女进行定期随诊的比例最高,为54.5％(6/11),其次为四川省西部地区医院,为25.9％(15/58).不同等级医院开设女性更年期门诊、门诊常规应用HRT治疗更年期综合征的比例分别比较,差异均有统计学意义(x2=10.199,P=0.006;x2 =7.694,P=0.021).其中,三级医院开设女性更年期门诊、门诊常规应用HRT治疗更年期综合征的比例,均为最高,分别为44.7％(21/47)、55.3％(26/47).④这193位医务人员中,认为有必要开设女性更年期门诊者占99.0％(191/193),不知道更年期综合征和绝经相关症状判断标准者占42.0％(81/193),在开展更年期妇女保健服务时,未使用更年期综合征和绝经相关症状判断标准者占69.9％(135/193),知道HRT但是认为HRT个体化治疗很困难者占80.9％(169/193),不知道HRT者占1.6％(3/193).接受调查医务人员中,71.0％(137/193)通过专业文献了解HRT.结论 四川省各级医疗机构的女性更年期保健门诊建设明显不足,医务人员对更年期妇女保健服务的相关基础理论知识掌握较差.四川省各级医疗机构应提高对更年期妇女保健重要性的认识,加强相关健康教育及相关设施、设备的建设,加强对女性更年期门诊的建设和管理,整体提高更年期妇女保健服务的综合水平.
