上海市社区全科医生对未分化疾病认知度和诊疗能力的自我评价研究  

Self-rated Capability of Identifying,Diagnosing and Treating Medically Unexplained Physical Symptoms in Shanghai General Practitioners in Community Health Centers

作　　者：周英达 卓书雄 金花 于德华[1,3,4,5] ZHOU Yingda;ZHUO Shuxiong;JIN Hua;YU Dehua(Department of General Practice,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China;Pudong New Area South Wharf Community Health Center,Shanghai 200125,China;Department of General Practice,Tongji University School of Medicine,Shanghai 200090,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Clinical Research Center for General Practice,Tongji University,Shanghai 200090,China)

机构地区：[1]同济大学附属杨浦医院全科医学科,上海市200090 [2]上海市浦东新区南码头社区卫生服务中心,200125 [3]同济大学医学院全科医学系,上海市200090 [4]上海市全科医学与社区卫生发展研究中心,200090 [5]同济大学全科医学临床研究中心,上海市200090

出　　处：《中国全科医学》2021年第31期3979-3985,共7页Chinese General Practice

基　　金：上海市领军人才(YDH-20170627);上海市卫生计生委课题(201840132);上海市医药卫生发展基金会课题(Se1201931);上海市浦东新区卫生健康委员会青年科技项目(PW2020B-20)。

摘　　要：背景随着基层医疗卫生机构改革的深化,社区未分化疾病逐渐被重视,且被认为对于基层医疗卫生机构整体服务能力的重要性不亚于慢性病管理,但目前国内关于全科医生对于未分化疾病诊疗情况的调查性或评价性研究相对少见。目的了解上海市社区全科医生对社区常见未分化疾病认知度和诊疗能力自我评价现况,并尝试分析其可能的影响因素,为优化社区常见未分化疾病诊疗提供参考。方法2019年6月至2020年6月,采用分层抽样的方法,抽取上海市城区和郊区的32家社区卫生服务中心的320例全科医生为研究对象。运用自制问卷了解全科医生对未分化疾病的认知度及诊疗能力自我评价情况。未分化疾病认知度及诊疗能力水平由被调查者依据Likert 5级量表评分自评。采用线性逐步回归分析全科医生未分化疾病诊疗能力水平影响因素。结果回收有效问卷283份,有效回收率为88.4%。158例(55.8%)全科医生对未分化疾病定义和概念完全不了解或仅听说过但不太了解。完成住院医师规范化培训的全科医生对未分化疾病概念及定义、未分化疾病国内外研究进展、未分化疾病相关书籍及指南认知度更高(P<0.05)。被调查全科医生自评的未分化疾病常规诊疗能力平均得分为(3.32±0.567)分、未分化疾病急危重症急救处理能力平均得分为(3.42±0.677)分、未分化疾病转诊能力平均得分为(3.38±0.654)分。线性逐步回归分析结果显示,是否完成住院医师规范化培训、学历、职称、工作所在区域是全科医生未分化疾病常规诊疗能力的影响因素(P<0.05);是否完成住院医师规范化培训是全科医生未分化疾病急危重症患者急救处理能力的影响因素(P<0.05);是否完成住院医师规范化培训、工作所在区域是全科医生未分化疾病患者转诊能力的影响因素(P<0.05)。结论全科医生对未分化疾病的认知度及诊�Background Increasing attentions have been given to medically unexplained physical symptoms(MUPS)with the deepening of primary healthcare reform,and the capability of primary care in managing MUPS is considered as equal to managing chronic diseases.However,there are few investigative or evaluative studies on the diagnosis and treatment of MUPS by general practitioners(GPs)in China.Objective To investigate the self-rated capability of identifying,diagnosing and treating MUPS of Shanghai GPs in primary care,and to attempt to explore the potential associated factors,providing a reference for raising GPs'capability of diagnosing and treating MUPS commonly encountered in the community.Methods This study was carried out from June 2019 to June 2020.By use of stratified random sampling,320 GPs from 32 community health centers in Shanghai's urban and suburban areas were selected(10 were extracted from each community health center).A 5-point Likert Scale Questionnaire developed by our research group was used in a survey to collect these GPs self-rated capability of identifying,diagnosing and treating MUPS.Stepwise linear regression was used to explore the factors potentially associated with GPs'capability of diagnosing and treating MUPS.Results A total of 283 cases(88.4%)who completed the survey were included for final analysis.One hundred and fifty-eight(55.8%)GPs knew nothing about the definition and concept of MUPS or knew of MUPS without good understanding of MUPS.GPs who had standardized residency training program had a better understanding of the definition and concept,research status,books for continuing education,and guidelines regarding MUPS(P<0.05).The average scores of self-rated capability of routinely diagnosing and treating MUPS,self-rated capability of emergently treating acute and severe MUPS,and self-rated capability of transferring MUPS patients by GPs,were(3.32±0.567),(3.42±0.677),(3.38±0.654),respectively.Stepwise linear regression revealed that whether completing the standardized residency training

关 键 词：未分化疾病 全科医生 认知度 临床工作能力 影响因素分析 

分 类 号：R192[医药卫生—卫生事业管理]