重庆市全科医师培训学员社区工作行为转化效果研究

Behavioral Transformation Effect of Community Work of Chongqing General Practitioners Trainees

目的评价重庆市全科医师培训后参训学员的社区工作行为转化效果。方法依据各区县社区卫生服务机构发展情况,选取沙坪坝、渝中、江津、南岸、璧山5个区县;依据学员参训基地所提供的2010、2011年全科医师培训名单,采用整群抽样方法,抽取以上5个区县参加重庆市全科医师培训结业后2~3年的社区卫生技术人员51例为参训学员组。按照整体1∶2配比对照原则,在参训学员所属机构抽取学员同事99例为学员同事组。采用方便抽样和目的性抽样,选取参训学员和学员同事1~3例患者,共选取参训学员接诊的患者128例,学员同事接诊的患者133例。于2014年9月采用自行设计的参训学员和学员同事调查问卷、患者调查问卷开展面对面调查。参训学员和学员同事调查问卷内容包括参训学员及学员同事的基本情况和全科医学认-知-行情况;患者调查问卷内容包括参训学员及学员同事接诊患者的基本情况和患者对参训学员及学员同事服务评价。参训学员和学员同事调查问卷共发放150份,回收有效问卷150份,问卷有效回收率为100.0%;患者调查问卷共发放261份,回收有效问卷261份,问卷有效回收率为100.0%。结果参训学员与学员同事在参加全科医学培训意愿、＂六位一体＂观念掌握、常见病多发病处理、识别危重病并转诊方面比较,差异有统计学意义（P〈0.05）;在是否承担非医疗业务比较,差异无统计学意义（P〉0.05）。在医生是否从多学科角度进行综合诊治、医生有无解释病情、医生有无解释治疗、医生处方当否、医生是否用药告知、医生是否主动回访、医生是否主动健康教育方面比较,差异无统计学意义（P〉0.05）;在医生有无耐心倾听、医生是否心理疏导方面比较,差异有统计学意义（P〈0.05）。结论全科医师参训学员社区工作行为改善,但还有待进一步提高。

Objective To evaluate behavioral transformation effect of community work of the participated trainees after the training of Chongqing general practitioners. Methods According to the development situation of community health service institutions in all districts and counties, we selected five districts and counties- Shapingba, Yuzhong, Jiangjin, Nanan,Bishan. According to the training list of general practitioners in 2010 and 2011 provided by the trainees base,we selected 51 community health workers who had already participated in the Chongqing general practitioner training for 2 ~ 3 years as the participated trainee group by adopting cluster sampling method. In accordance with the overall 1∶ 2 matching control principle,99 cases from the institutions of the trainees were selected as the colleague group. We selected 1 ~ 3 patients who had received treatment of trainees and trainees colleagues by using convenience sampling and purposive sampling,and 128 patients treated by trainees and 133 patients treated by trainee colleagues were selected totally. In September 2014,face- to- face survey was carried out by the self- designed questionnaires of trainees and their colleagues and patients. Questionnaire of trainees and their colleagues included the basic information of trainees and their colleagues and the identify- aware- perform conditions of general practitioners. Questionnaire of patients included the basic information of patients treated by trainees and their colleagues and patients＇ evaluations towards the service of participated trainees and their colleagues. We issued 150 questionnaires of trainees and trainee colleagues, and recovered 150 valid questionnaires with an effective recponse rate of 100. 0%, a patient 261 questionnaires of patients were issued,261 valid questionnaires were recovered with an effective recponse rate of 100. 0%.Results There was significant difference in the willingness to participate in general practice training,mastering of ＂ six- in-one＂ concept, treatment of common disease and frequently- occurring disease, and identify critical patients and referrals between the participated trainees and trainee colleagues（ P〈0. 05）. There was no significant difference in whether undertaking the non- medical business between participated trainees and trainee colleagues（ P〈0. 05）. There was no significant difference in whether the doctors performed the diagnosis and treatment from a multidisciplinary perspective,whether doctors explained the state of illness,whether doctors explained treatments,whether the prescription made by doctors proper or not,whether doctors made medication information,whether doctors paid a return visit initiatively,and whether doctors provided health education to patients actively between participated trainees and trainee colleagues（ P〈0. 05）. There was significant difference in whether doctors had patience in listening to patients and whether doctors proceeded psychological counseling between participated trainees and trainee colleagues（ P〈0. 05）. Conclusion There are improvements in community work behaviors of participated trainees,which needs further improvement.