基于先进国家评估标准的大连市社区医生业务能力自评调查

Self-assessment of Community Physicians' Professional Capabilities in Dalian Based on the Evaluation Criteria of Developed Countries

目的调查大连市社区医生业务能力自评情况,了解社区医生业务能力自评现状,寻找提高社区医生综合能力的有效途径。方法于2015年7月,选取大连市4个辖区(A区、B区、C区、D区)66个社区卫生服务中心的社区医生为调查对象。根据美国家庭医疗学会制定的美国家庭医生研修标准以及日本社区医生业务能力要求,结合我国社区全科医生能力培训要求,制定社区医生业务能力自评量表,主要包括6个维度:社区管理能力、保健指导能力、疾病诊断能力、健康管理能力、急救管理能力、科研管理能力,共42个问题。各维度结构系数均为0.4以上,量表内部一致性Cronbach'sα系数为0.976。共发放问卷512份,回收有效问卷512份,有效回收率为100.0%。结果社区医生总体业务能力自评得分率为56.1%(117.9/210),其中社区管理能力、保健指导能力、疾病诊断能力、健康管理能力、急救管理能力、科研管理能力自评得分率分别为56.8%(14.2/25)、58.9%(20.6/35)、58.2%(26.2/45)、57.4%(28.7/50)、57.2%(14.3/25)、46.3%(13.9/30)。不同辖区的社区医生社区管理能力、保健指导能力、疾病诊断能力、健康管理能力、急救管理能力、科研管理能力及总体业务能力自评得分率间差异均有统计学意义(P<0.05)。不同学历的社区医生社区管理能力、保健指导能力、疾病诊断能力、健康管理能力及总体业务能力自评得分率间差异有统计学意义(P<0.05),而急救管理能力、科研管理能力自评得分率间差异无统计学意义(P>0.05)。不同社区工作年限的社区医生社区管理能力、保健指导能力、疾病诊断能力及总体业务能力自评得分率间差异无统计学意义(P>0.05),而健康管理能力、急救管理能力、科研管理能力自评得分率间差异有统计学意义(P<0.05)。结论社区医生总体业务能力自评水平不佳,各辖区社区医生业务能力自评水平间有差异,应注重社区医生整体业务能力水平的提升。

Objective To search for effective ways to improve the comprehensive capabilities of community physicians based on the current situation demonstrated by the self- assessment survey of community physicians＇ professional capabilities in Dalian. Methods The community physicians from 66 community health service centers in Dalian＇s four districts（ A District,B District,C District and D District） were selected as the subjects of this study in July 2015. In accordance with the training standards for family doctors proposed by American Academy of Family Physicians, required professional competences of community physicians in Japan and the current training demands of general practitioners in China,we developed the Community Physicians Professional Capabilities Self- rating Scale,which mainly included 6 dimensions covering 42 problems： communitymanagement ability,health care guidance ability,disease diagnosis ability,health management ability,emergency management ability and scientific research management ability. The structure coefficient of each dimension was more than 0. 4, and the Cronbach＇s α was 0. 976. A total of 512 questionnaires were issued and recovered with an effective response rate of 100. 0%.Results The results of the survey showed that the self- rated scoring rate of overall professional capabilities of the community physicians was 56. 1%（ 117. 9 /210）,and that of the community management ability,health care guidance ability,disease diagnosis ability,health management ability,emergency management ability,scientific research management ability was 56. 8%（ 14. 2 /25）,58. 9%（ 20. 6 /35）,58. 2%（ 26. 2 /45）,57. 4%（ 28. 7 /50）,57. 2%（ 14. 3 /25）,46. 3%（ 13. 9 /30）respectively. The differences in terms of self- rated scoring rate of community management ability,health care guidance ability,disease diagnosis ability,health management ability,emergency management ability,scientific research management ability and overall professional capabilities between community physicians in different districts showed statistical significance（ P〈0. 05）.Between community physicians with different academic qualifications, the differences in terms of self- rated scoring rate of community management ability,health care guidance ability,disease diagnosis ability,health management ability,and overall professional capabilities were statistically significant（ P〈0. 05）,while those in emergency management ability and scientific research management ability were not（ P〈0. 05）. Between community physicians with different time of service,the differences in terms of self- rated scoring rate of health management ability, emergency management ability and scientific research management ability demonstrated statistical significance（ P〈0. 05）,while those in community management ability,health care guidance ability,disease diagnosis ability,and overall professional capabilities did not（ P〈0. 05）. Conclusion The self-rated overall professional capabilities of community physicians in Dalian are relatively low. And the self- rated professional capabilities of community physicians vary from district to district. Therefore,emphasis should be put on the improvement of overall level of professional capabilities of community physicians.