北京市社区卫生服务中心全科医生接诊儿童情况及其相关培训调查研究

Research of General Practitioners' Reception of Children and Related Training in Community Health Service Centers in Beijing

目的了解北京市社区卫生服务中心全科医生接诊儿童情况及儿科相关培训信息,为建立初级医疗卫生服务机构接诊儿童体系、实现儿童分级诊疗提供参考。方法 2014年9—11月采用分层整群抽样法选取北京市3个城区12家社区卫生服务中心符合纳入与排除标准的全科医生为调查对象。采用横断面调查方法对全科医生进行问卷调查,调查内容为全科医生一般资料（包括性别、年龄、学历、职称、工作时间）、全科医生接诊儿童情况（包括以前接诊儿童情况、现在接诊儿童情况）、全科医生接诊儿童态度（包括是否赞成接诊儿童及认为社区卫生服务中心无法接诊儿童的原因）、全科医生接诊儿童能力自评、全科医生毕业后儿科相关培训情况（包括毕业后是否接受过儿科相关培训、培训期间接诊儿童情况、已接受培训时间、期望接受培训时间）。结果共调查348例全科医生,问卷填写完整者339例,应答率为97.4%。100例（29.5%）过去接诊儿童,而现在接诊儿童的只有14例（4.1%）,差异有统计学意义（χ~2=16.900,P〈0.05）。250例（73.7%）不赞成全科医生接诊儿童。对于社区卫生服务中心无法接诊儿童的原因,255例（75.2%）认为全科医生诊疗能力及相关训练不够,193例（56.9%）认为社区卫生服务中心就诊儿童疾病谱复杂,183例（54.0%）认为社区卫生服务中心不具备儿童相关化验检查能力。100例（29.5%）认为自己接诊儿童能力差,189例（55.7%）认为自己接诊儿童能力很差。101例（29.8%）全科医生毕业后接受过儿科相关培训,其中只有33例（32.7%）在培训期间接诊过儿童;60.4%（61/101）已接受培训时间〈2个月,82.2%（83/101）期望接受培训时间≥2个月。全科医生已接受培训时间和期望接受培训时间比较,差异有统计学意义（P〈0.05）。结论北京市社区卫生服务中心接诊儿童的功能正在逐渐萎缩,建议加强该区域社区卫生服务中心全科医生毕业后儿科相关培训,加强其接诊儿童能力,并且制定相应政策鼓励社区卫生服务机构接诊儿童,进而实行安全有效的分级诊疗。

Objective To investigate the current situation of general practitioners＇ reception of children and related training in community health centers in Beijing. Methods From September to December in 2014, general practitioners who accorded with inclusion and exclusion criteria from 12 community health centers in 3 districts of Beijing by stratified cluster sampling method were enrolled in the study. Cross - sectional survey method was employed to conduct questionnaire survey on the included general practitioners. Survey content included general data （ including gender, age, education background, professional titles and working time） , subjects＇ reception of children （including previous reception and current reception） , subjects＇ attitude toward children reception （ including agreeing with children reception or not and the reasons why community health service centers can＇t receive children ）, assessment of subjects＇ ability of children reception, the status of relevant training after graduation （including having received relevant training or not, children reception during training, training time, expected training time）. Results A total of 348 general practitioners took part in the survey, and 339 general practitioners completed questionnaires,with a response rate of 97.4%. The number of children received in the past was 100 （ 29.5% ） , and the number of children received at present was 14 （4. 1% ） , and the difference was significant （ X2 = 16. 900, P 〈 0. 05 ） . There were 250 （ 73.7% ） subjects who didn＇t agree with GP reception of children. The reasons why community health service centers couldn＇t receive children were as follows： 255 （75.2%） thought the ability of diagnosis and treatment and relevant training were inadequate; 193 （56.9%） thought children received at community health centers had complex spectrum of disease; 183 （54.0%） thought community health centers didn＇t have the ability to conduct relevant laboratory examination. There were 100 （29.5%） subjects who thought they had poor ability of children reception, and 189 （55.7%） subjects thought that they had very poor ability of children reception. There were 101 （29. 8% ） patients who had received relevant training, while only 33 （32. 7% ） subjects had received children during training; 60.4% （61/101） of the subjects received training 〈2 months, 82. 2% （83/101） expected to receive training ≥ 2 months. There was significant difference between training time and expected training time of general practitioners （ P 〈 0. 05 ） . Conclusion The ability of children reception is decreasing among community health centers in Beijing, and relevant training on general practitioners in the community health centers in this regions after their graduation should be strengthened, and the ability of children reception should be promoted. Corresponding policies should be formulated to stimulate children reception in community health centers, in order to conduct safe and effective stratified diagnosis and treatment.