基层全科医生医防融合能力评价指标体系构建

Construction of evaluation index system of general practitioners’integration capability of medical care and preventive services in primary care

目的构建基层全科医生医防融合能力评价指标体系,探索提高基层全科医生医防融合服务能力的方法。方法用改良的德尔菲法构建基层全科医生医防融合能力评价指标体系,用界值法筛选指标,评价专家积极性、专家咨询权威程度和专家意见协调程度,用层次分析法计算指标权重系数。结果共发放专家咨询问卷33份,第1轮和第2轮有效问卷回收率分别为100.0%(33份)和97.0%(32份)。总体指标专家权威系数为0.80。2轮专家咨询后,三级指标和总体指标重要性的肯德尔协调系数分别为0.677、0.683,χ^(2)值分别为88.774、91.663(P均<0.001)。基层全科医生医防融合能力评价指标体系包含3个一级指标、10个二级指标和36个三级指标。一级指标“B能力、技能、技术方面医防融合能力”权重最高,为0.5000。三级指标组合权重排序前5位从高到低依次为:C11主动服务基层居民的意识(0.0817)、B12掌握院前急救技术(0.0757)、A11掌握合理用药及预防知识(0.0677)、A22掌握传染病预防控制理论(0.0556)和C12主动提供卫生服务的意识(0.0520)。结论从知识结构、能力、技能与技术、素质等3个维度系统构建了基层全科医生医防融合能力评价指标体系,可为基层全科医生医防融合能力评价以及系统设计与开发继续教育培训项目提供参考。

Objective To develop an evaluation index system of general practitioners’integration capabilities of medical care and preventive services in primary care,and to explore pathways to enhance their service capabilities.Methods The improved Delphi method was used with the threshold method in indicator screening.The evaluation index system also incorporated the indices of expert enthusiasm,expert consultation authority,and coordination of expert opinions.The analytic hierarchy process(AHP)was then employed to calculate the weight coefficients of the indicators.Results A total of 33 expert consultation questionnaires were distributed,and the effective questionnaire recovery rates for the first and second rounds were 100.0%and 97.0%,respectively.The expert consultation authority coefficient for overall indicators was 0.80.After two rounds of expert consultation,the Kendall’s W coefficients for the importance of the tertiary and overall indicators were 0.677 and 0.683.χ^(2)values were 88.774 and 91.663,respectively,with all P<0.001.This system comprised 3 first-level indicators,10 second-level indicators,and 36 third-level indicators.Among them,the first-level indicator B“Integrated Capability in terms of capacity,skills,and techniques”had the highest weight of 0.5000.The top five combined weights in the third-level indicators in descending order were:C11 awareness of actively serving residents(0.0817),B12 proficient in pre-hospital emergency technology(0.0757),A11 proficient in rational medication and prevention knowledge(0.0677),A22 proficient in infectious disease prevention and control theory(0.0556),and C12 awareness of actively providing health services(0.0520).Conclusions This article systematically constructed an evaluation index system of general practitioners’integration capabilities of medical care and preventive services in primary care from three dimensions:knowledge structure,capability,skills,techniques along with quality.It offers insights for evaluating general practitioners’integration capability of medical care and preventive services in primary care as well as the systematic design and advance of continuing education and training programs.