北京地区全科医生医疗和公共卫生服务提供现状及问题研究

The Status Quo of Medical Care and Public Health Service Provided by General Practitioners in Beijing and Existing Problems

目的了解北京市全科医生基本医疗和基本公共卫生服务的提供现状及存在的问题,为北京市完善全科医生工作相关政策提供参考。方法采用自制调查问卷,对2012年11月参加北京市全科医生转岗培训和社区师资培训的53名全科医生进行自填式问卷调查。结果 53名被调查的全科医生在通常1 d的工作中,最常进行的基本医疗工作依次为常见病诊疗(100.0%)、转诊服务(54.7%)、出诊服务(45.3%)、急诊急救服务(39.6%)等;在过去两周中提供的基本公共卫生服务依次为社区健康信息管理(90.6%)、慢性非传染性疾病管理(66.0%)、老年保健(54.7%)和群体健康教育(54.7%)等;有22人(41.5%)承担着统计报表、社会流行病学调查(流调)等管理性工作。在53名全科医生中,有41人(77.4%)认为工作时间分配不合理,26人(49.1%)认为其在做一些不应该由全科医生做的行政管理工作,52人(98.1%)认为目前北京市全科医生的执业范围不明确,50人(94.3%)认为社区卫生服务团队的分工存在问题;有37人(74.0%)认为社区卫生服务内容中计划生育、精神疾病管理、妇女保健等工作应该由公卫医师承担,有16人(30.2%)认为社区健康信息管理工作不应该由全科医生承担。结论全科医生所提供的基本医疗和基本公共卫生服务欠规范,社区卫生服务团队成员之间的职责与分工需进一步明确,尽快研究和明确全科医生的执业范围、细化服务内容规范将成为今后全科医学领域研究的重点内容之一。

Objective To investigate the status quo of medical care and public health services provided by general practitioners （GPs） in Beijing. Methods Fifty - three GP trainees who attended the general practice job - transfer training and community faculty training in Beijing were surveyed in November 2012 using self - designed questionnaire. Results The most fie- quently provided medical care services were diagnosis and treatment of common diseases （100.0%）, referral （54.7%）, home visit （45.3%）, emergency care （39. 6% ）, etc. Public health services provided by the investigated GPs in the past 2 weeks were management of health information （90. 6% ）, management of chronic diseases （66.0%）, geriatric care （54.7%）, and health education （54. 7% ）. Twenty -two out of 53 GPs undertook managerial work, such as statistical report and epidemiologi- cal survey. Inappropriate working time distribution （41/53, 77. 4% ）, unreasonable managerial responsibilities （26/53, 49. I% ）, unclear scope of practice （52/53, 98.1% ）, inappropriate division of labor in community health service team （50/ 53, 94. 3% ） were the major problems raised by the GPs. Thirty - seven （74.0%） of the GPs thought family planning, manage- ment of psychiatric patients, and women health care should be undertaken by public health physicians, and 16 （30. 2% ） of the GPs thought management of health information should not be their responsibility. Conclusion There＇re no defined standards for medical care and public health service provided by GPs. The responsibility and labor division of health professionals in community health service team should be defined. The practice scope of GPs and standardization of service will be a critical research field in general practice.