Jia Huanhuan, Cao Peng, Yu Jianxing, Zhang Jingru, Jiang Hairui, Zhao Qize, Yu Xihe
School of Public Health, Jilin University, Changchun 130000, China.
Jilin Province Healthcare Security Administration Management Center, Changchun 130000, China.
Int J Environ Res Public Health. 2021 Mar 4;18(5):2560. doi: 10.3390/ijerph18052560.
In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.
在包括中国在内的一些国家，由于基层医疗卫生机构（PMHCIs）医务人员短缺，基层医疗卫生服务很少得到利用。多项研究表明，最有效的解决办法是引导合格医生和医学毕业生到基层医疗卫生机构工作，但这些研究和措施仅从政府和基层医疗卫生机构的角度制定；很少有人考虑医务人员的主观意愿。因此，有必要从引导对象的角度探索基层医疗卫生机构人力资源开发的措施。本研究基于内隐理论和词汇法分为两部分。第一部分收集影响他们选择到基层医疗卫生机构就业的因素，第二部分采用探索性因素分析（EFA）、验证性因素分析（CFA）和结构方程模型（SEM）来探索影响因素的维度和路径。最后，通过探索性因素分析得到了七个因素，结构方程模型假设与数据拟合良好。内部组织发展、患者因素、薪酬与发展以及家庭支持对到基层医疗卫生机构求职的医务人员的获得感有显著正向影响，而工作职责和基层医疗卫生机构所在城市的条件则没有显著影响。此外，内部组织发展和基层医疗卫生机构所在城市的条件对获得感的间接影响显著。患者因素、家庭支持以及薪酬与发展显著中介了机构内部和外部环境与获得感之间的关系，而工作职责的中介作用不显著。家庭支持、薪酬与发展以及患者因素的改善会增加医务人员到基层医疗卫生机构就业的意愿。此外，基层医疗卫生机构的内部和外部环境在引导医务人员到基层医疗卫生机构就业方面起着至关重要的作用。本研究为改善人力资源开发、引导医务人员到基层医疗卫生机构工作以及促进基层医疗卫生服务的利用提供了理论支持。
