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医防融合视角下我国基层医生健康管理服务能力现状分析

Ability of health management services among grassroots doctors under the integration of disease treatment and prevention in China, 2020: an online self-administered survey

  • 摘要:
    目的 从医防融合视角,探讨基层医生常见病诊治能力水平与健康管理服务能力具备情况的关联,为提高基层医生的健康管理服务能力提供参考。
    方法 于2020年8月,采用多阶段分层抽样与典型抽样相结合的方法,对中国东、中、西部基层医疗卫生机构的8 469名医生进行线上问卷调查,利用课题组既往开发的基层医生卫生服务能力指标体系,选取其中健康管理服务能力部分的指标为依据设计调查问卷,从常见病诊治、健康管理、健康促进3个方面评价基层医生健康管理服务能力的具备情况。
    结果 8 469名基层医生中,取得执业(助理)医师资格5 288人(62.44%),乡村医生2 201人(25.99%)。基层医生具备常见病诊治能力人数6 497人(76.72%);在儿童健康管理能力方面,基层医生具备儿童营养指导、体格检查能力人数分别为7 099(83.82%)和7 068(83.46%)人;在妇女健康管理能力方面,基层医生具备计生指导、孕期健康指导、围绝经期健康、妇科两癌筛查的人数分别为6 746(79.66%)、6 539(77.21%)、5 921(69.91%)、5 456(64.42%)人;在老年人、慢性病健康管理方面,基层医生具备老年人和慢性病健康管理的比例均>90%;在健康促进方面,基层医生具备社区健康问题分析能力的人数最低,有6 234人(73.61%)。
    结论 高素质人才短缺和常见病诊治能力影响基层医生开展健康管理服务,且我国基层医生掌握健康管理服务能力存在“短板”,因此需要加强医院与基层之间服务协同机制建设。

     

    Abstract:
    Objective To explore the association between the ability to diagnose and treat common diseases and the capacity to provide health management services among grassroots doctors, from the perspective of integrating disease treatment and prevention, and to provide a reference for improving grassroots doctors’ health management service capacity.
    Methods An online self-administered questionnaire survey was conducted in August 2020 among 8 469 specialists, general practitioners, and rural doctors. Participants were recruited using stratified multi-stage sampling and typical sampling from primary healthcare institutions located in 11 municipalities across eastern, central, and western China. Utilizing a previously self-developed index system for evaluating the health service capabilities of grassroots doctors, the survey questionnaire was designed based on indicators related to health management service capabilities. The questionnaire assessed the health management service capabilities of primary care physicians in three areas: diagnosis and treatment of common diseases, health management, and health promotion.
    Results Of all the participants, 5 288 (62.44%) were practicing (assistant) doctors, 2 201 (25.99%) were rural doctors, and 6 497 (76.72%) were assessed as capable of diagnosing and treating common diseases. Among all the grassroots doctors surveyed, 7 099 (83.82%) had the ability to provide nutritional guidance for children, and 7 068 (83.46%) could conduct physical examinations for children as part of children's health management. Regarding women's health management, 6 746 (79.66%) could provide family planning guidance, 6 539 (77.21%) offered prenatal health guidance, 5 921 (69.91%) provided perimenopausal health care, and 5 456 (64.42%) conducted cervical/breast cancer screening. More than 90% of the participants were assessed as able to conduct health management for the elderly and individuals with chronic conditions. However, only 6 234 (73.61%) had the ability to analyze community health issues.
    Conclusions The ability to diagnose and treat common illnesses significantly affects the capacity of grassroots doctors to deliver health management services. Moreover, there is a noticeable gap in the health management service capabilities among grassroots doctors in China. Therefore, it is crucial to strengthen collaborative service mechanisms between hospitals and primary care institutions.

     

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