北京农村地区全科医生工作现状及影响因素研究

Working status of rural general practitioners in Beijing and its influencing factors

目的调查北京农村地区全科医生的工作现状及影响因素,为今后农村地区培养全科医生和制订相关政策提供参考。方法采用自设问卷,对北京郊区县11家社区卫生服务中心/乡镇卫生院的90名全科医生实施自填式问卷调查。结果 161.1%的被调查者1周内工作时间主要以基本诊疗工作为主;21 d中最常提供的医疗服务为常见疾病诊治(100.0%)、院内急诊(77.1%)和转诊(55.6%),最常提供的基本公共卫生服务是社区健康信息管理(91.1%)、群体健康教育(76.7%)、老年人健康管理(75.6%)、慢性非传染性疾病管理(73.3%)和疾病的筛检(51.1%)等,有部分医生会参与行政管理(36.7%)、科研(15.6%)、教学(42.2%)等工作;365.5%的被调查者认为合理的工作时间分配是以基本诊疗工作为主,应减少管理性及其他非本专业的事务性工作;4认为最应该承担的基本公共卫生工作是社区健康信息管理(95.6%)、群体健康教育(87.8%)、老年人健康管理(84.4%);577.8%的被调查者认为自己不应该参与行政管理工作;6居民缺乏疾病预防意识,仍以病后就医为主(85.6%)、全科医生收入低(80.0%)、服务范围大,开展连续性诊疗服务工作困难(80.0%)等被认为是影响农村地区提供基本医疗的主要因素。结论明确农村地区全科医生的工作内容、划分其工作范围、完善工作职责、提高工作待遇、加强全科医疗宣传等相关政策的制订及实施迫在眉睫。

Objective To investigate the working status and influencing factors of general practitioners （GPs） in rural area of Beijing, in order to provide reference to cultivate GPs in rural area and formulate relevant policies. Methods 90 GPs from 11 community health service centers or township hospitals were investigated by self-designed questionnaires. Results ①61.1% of the GPs spent most of their time in a week in providing basic medical care. ②The most frequent health care provided by the investigated GPs in a day were diagnosis and treatment of common diseases （100.0%）, emergency treatment （77.1%）, and referral （55.6%）. The most frequent basic public health services provided in a day were management of health information （91.1.%）, health education for community （76.7%）, health management of the elderly （75.6%）, management of chronic diseases （73.3%）, and disease screening （51.1%）. Some of the GPs also under- took administrative （36.7%）, research （15.6%）, and teaching （42.2%） tasks. ③65.5% of the GPs thought that diagnosis and treatment of diseases should occupy the most of working time and administrative work or other work irrelevant with diagnosis and treatment should be reduced. ④The appropriate basic public health services for GPs should be manage- ment of health information （95.6%）, health education for community （87.8%）, and health management of the elderly（84.4%）. ⑤77.8% of the GPs thought that they should not undertake administrative works. ⑥The main influ- encing factors on the provision of basic medical ser- vices in rural areas included the absence of preventive awareness for residents who mainly visited the doctors after illness （85.6%）, low income of GPs （80.0%）, large scope of services, and difficulties in carrying outcontinuity services （80.0%）. Conclusion Defining the work contents of GPs in rural areas, division of work scope, so- phisticating responsibilities of GPs, improving GPs＂ income, and strengthening publicity of general practice are urgent tasks for policy making and implementation.