農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策的系統(tǒng)評價再評價
發(fā)布時間：2018-10-19 13:18
【摘要】：目的農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源不足已是全球性衛(wèi)生問題之一,嚴重影響著各國衛(wèi)生公平的實現(xiàn)。但是,由于農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策的研究證據(jù)良莠不齊,各國要循證決策、科學高效地解決這一衛(wèi)生問題仍然面臨著長期而巨大的挑戰(zhàn)。本研究采用循證醫(yī)學的研究方法,全面分析、評價農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策的研究證據(jù),以便為決策者和政策研究者提供參考。 方法計算機檢索PubMed、Cochrane Library、Campbell Library、Web of Science、中國生物醫(yī)學數(shù)據(jù)庫、相關(guān)期刊論文、中文科技期刊全文數(shù)據(jù)庫、中國學術(shù)期刊數(shù)據(jù)庫等數(shù)據(jù)庫,世界衛(wèi)生組織網(wǎng)站和Google學術(shù)搜索引擎；手工檢索相關(guān)研究的參考文獻。檢索時間截止至2014年3月,不限制文獻發(fā)表的時間。納入關(guān)于農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策的系統(tǒng)評價。從研究基本特征、方法學特征和質(zhì)量特征方面進行資料提取。采用AMSTAR量表評價納入研究的方法學質(zhì)量；以世界衛(wèi)生組織提供的16條政策建議為基本框架,分類綜合、分析納入研究所針對的挽留政策；利用Excel2003設(shè)計資料提取表并進行數(shù)據(jù)分析。 結(jié)果根據(jù)納入與排除標準,共納入系統(tǒng)評價14篇,其中10篇(71.4%)系統(tǒng)評價發(fā)表于2009至2013年；2篇(14.3%)系統(tǒng)評價納入了中低收入國家的原始研究；僅1篇(7.1%)系統(tǒng)評價納入了隨機對照試驗研究。質(zhì)量評價結(jié)果顯示,這些系統(tǒng)評價的方法學質(zhì)量等級分別為中(8篇,57.1%)和低(6篇,42.9%)。證據(jù)綜合分析顯示,16條政策建議中,“使各類醫(yī)學生有在農(nóng)村地區(qū)臨床實習的經(jīng)歷”挽留政策的系統(tǒng)評價研究最多(6篇,42.9%);“發(fā)展針對于農(nóng)村衛(wèi)生工作者的醫(yī)學繼續(xù)教育”、“擴大農(nóng)村衛(wèi)生工作者的執(zhí)業(yè)范圍“引進不同類型的衛(wèi)生工作者”、“改善衛(wèi)生工作者及其家人的生活條件并投資于基礎(chǔ)設(shè)施和服務(wù)”、“提高公眾認可度”等5項挽留政策尚無系統(tǒng)評價研究。目前尚無系統(tǒng)評價研究16條政策建議之外的其它挽留政策。 結(jié)論研究表明,大部分農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策缺乏循證醫(yī)學證據(jù)的支持；現(xiàn)有研究證據(jù)數(shù)量少,方法學質(zhì)量不高；研究類型以觀察性研究為主,且主要來自高收入國家。提示我們亟需加強農(nóng)村及偏遠地區(qū)衛(wèi)生人力資源挽留政策的研究,特別要重視針對中低收入國家開展相關(guān)研究,強化循證決策意識。
[Abstract]:Objective the shortage of health human resources in rural and remote areas is one of the global health problems, which seriously affects the realization of health equity in various countries. However, due to the mixed evidence of rural and remote health human resource retention policy, countries to make evidence-based decision-making, scientific and efficient solution to this health problem is still facing a long-term and huge challenges. In this study, evidence-based medicine (EBM) was used to analyze and evaluate the evidence of health human resource retention policy in rural and remote areas, in order to provide reference for policy makers and policy researchers. Methods PubMed,Cochrane Library,Campbell Library,Web of Science, Chinese biomedical database, Chinese journal full-text database, Chinese sci-tech journal full-text database, Chinese academic journal database, WHO website and Google academic search engine were searched by computer. Manual retrieval of related research references. The search time is up to March 2014, and there is no restriction on the time of publication. To include a systematic evaluation of health human resource retention policies in rural and remote areas. The data are extracted from basic features, methodological features and quality features. The AMSTAR scale was used to evaluate the methodological quality of the study, the 16 policy recommendations provided by the World Health Organization were used as the basic framework, the classification and synthesis were used to analyze the retention policies targeted by the Institute. Use Excel2003 to design data extraction table and data analysis. Results according to the inclusion and exclusion criteria, a total of 14 systematic evaluations were included, of which 10 (71.4%) were published from 2009 to 2013, 2 (14.3%) included original studies in low- and middle-income countries; Only one (7.1%) systematic evaluation was included in a randomized controlled trial. The results of quality evaluation showed that the methodological quality grades of these systematic evaluations were middle (8, 57.1%) and low (6, 42.9%), respectively. A comprehensive analysis of the evidence shows that among the 16 policy recommendations, the number of systematic evaluation studies on the retention policy "making all kinds of medical students have clinical practice experience in rural areas" (6 articles, 42.9%) and "developing medical continuing education for rural health workers" was the largest. "to expand the practice of rural health workers" and to introduce different types of health workers "to improve the living conditions of health workers and their families and to invest in infrastructure and services", There is no systematic evaluation of the five retention policies. There is no systematic evaluation of retention policies other than 16 policy recommendations. Conclusion most rural and remote health human resources retention policies lack the support of evidence-based medical evidence, the quantity of existing research evidence is small, the quality of methodology is not high, and the main types of research are observational research. And mainly from high-income countries. It is suggested that we need to strengthen the research on the retention policy of health human resources in rural and remote areas, and pay special attention to the relevant research for low- and middle-income countries, and strengthen the awareness of evidence-based decision-making.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.62
[Abstract]:Objective the shortage of health human resources in rural and remote areas is one of the global health problems, which seriously affects the realization of health equity in various countries. However, due to the mixed evidence of rural and remote health human resource retention policy, countries to make evidence-based decision-making, scientific and efficient solution to this health problem is still facing a long-term and huge challenges. In this study, evidence-based medicine (EBM) was used to analyze and evaluate the evidence of health human resource retention policy in rural and remote areas, in order to provide reference for policy makers and policy researchers. Methods PubMed,Cochrane Library,Campbell Library,Web of Science, Chinese biomedical database, Chinese journal full-text database, Chinese sci-tech journal full-text database, Chinese academic journal database, WHO website and Google academic search engine were searched by computer. Manual retrieval of related research references. The search time is up to March 2014, and there is no restriction on the time of publication. To include a systematic evaluation of health human resource retention policies in rural and remote areas. The data are extracted from basic features, methodological features and quality features. The AMSTAR scale was used to evaluate the methodological quality of the study, the 16 policy recommendations provided by the World Health Organization were used as the basic framework, the classification and synthesis were used to analyze the retention policies targeted by the Institute. Use Excel2003 to design data extraction table and data analysis. Results according to the inclusion and exclusion criteria, a total of 14 systematic evaluations were included, of which 10 (71.4%) were published from 2009 to 2013, 2 (14.3%) included original studies in low- and middle-income countries; Only one (7.1%) systematic evaluation was included in a randomized controlled trial. The results of quality evaluation showed that the methodological quality grades of these systematic evaluations were middle (8, 57.1%) and low (6, 42.9%), respectively. A comprehensive analysis of the evidence shows that among the 16 policy recommendations, the number of systematic evaluation studies on the retention policy "making all kinds of medical students have clinical practice experience in rural areas" (6 articles, 42.9%) and "developing medical continuing education for rural health workers" was the largest. "to expand the practice of rural health workers" and to introduce different types of health workers "to improve the living conditions of health workers and their families and to invest in infrastructure and services", There is no systematic evaluation of the five retention policies. There is no systematic evaluation of retention policies other than 16 policy recommendations. Conclusion most rural and remote health human resources retention policies lack the support of evidence-based medical evidence, the quantity of existing research evidence is small, the quality of methodology is not high, and the main types of research are observational research. And mainly from high-income countries. It is suggested that we need to strengthen the research on the retention policy of health human resources in rural and remote areas, and pay special attention to the relevant research for low- and middle-income countries, and strengthen the awareness of evidence-based decision-making.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.62
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