成都市基层医疗卫生机构管理者视角下公共卫生执业医师处方权研究  

Research on Public Health Practitioners Prescription Rights from the Perspective of Managers of Grassroots Medical Institution in Chengdu City

作　　者：李星月 吕良 李佳圆[1,2] 杨珉[1] 邹锟 LI Xingyue(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西公共卫生学院,四川大学华西第四医院,四川成都610041 [2]四川大学华西-协和陈志潜卫生健康研究院公共卫生教育研究中心,四川成都610041 [3]四川大学华西第二医院药学部,四川大学华西第二医院循证药学中心,四川成都610041

出　　处：《医学与社会》2023年第7期74-78,共5页Medicine and Society

基　　金：国家重点研发计划项目课题,编号为2020YFC2006505;中华医学基金会资助项目,编号为GRANT16-252。

摘　　要：目的:从成都市基层医疗卫生机构管理者视角,了解公共卫生执业医师处方权缺失现状和不良影响,及其对授予公卫医师处方权的态度和建议,为探索授予基层公卫医师处方权、完善公卫医师制度提供参考。方法:采用目的抽样和扎根理论的研究方法,对成都市7家基层医疗卫生机构的12位管理者进行深度访谈和焦点小组讨论,经过开放式编码、主轴编码和选择性编码对基层公卫医师处方权相关问题进行探索分析。结果:经过三级编码,最终提炼出49个初始范畴,8个主范畴和4个核心范畴,在此基础上构建基层公卫医师处方权研究的理论框架,该框架模型主要包括现实层(现状影响)、支持层(内外条件)、操作层(具体建议)和效应层(预期改变)。结论:基层公卫医师普遍缺失处方权,并造成诸多不良影响。应该明确基层公卫医师处方权政策,完善公卫医师制度,优化基层医师资源分配,并通过规范化培训和处方管理等措施强化公卫医师临床理论和实践能力,提高基层医疗质量,推进基层医防融合发展。Objective:To understand the current situation and adverse effects of the lack of prescription right of public health practitioners(PHPs),and to explore the attitudes and suggestions on authorizing prescription right to PHPs from the perspective of managers of grassroots medical institutions in Chengdu,so as to provide references for exploring and granting prescription right to PHPs and improving the practice system of PHPs.Methods:Based on purposive sampling and grounded theory,12 managers from 7 grassroots medical institutions in Chengdu were interviewed using in-depth interviews and focus groups.We analyzed the issues of prescription right of grassroots PHPs through open coding,axial coding and selective coding.Results:After three level coding,49 initial categories,8 main categories and 4 core categories were concluded.On this basis,the theoretical framework of prescription right research for grassroots PHPs was constructed,mainly including four layers,namely reality layer(current situation and influence),support layer(conditions of outside and inside),operation layer(practical suggestions)and effect layer(change of expectation),respectively.Conclusion:Grassroots PHPs generally lack prescription right,resulting in a lot of adverse effects.It is suggested that policies of prescription right of grassroots PHPs should be clarified,the practice system of PHPs should be improved,and the distribution of grassroots practitioner resources should be optimized.At the same time,standardized training and prescription management and other measures should be taken to strengthen the clinical theory and practice ability of PHPs,improve the quality of grassroots medical care,and finally promote the development of grassroots medical and preventive integration.

关 键 词：处方权 公共卫生执业医师 基层医疗卫生机构 成都 

分 类 号：R197.6[医药卫生—卫生事业管理]