北京市基层全科医生对慢性肾脏病的认知调查

Cognition of Grass-roots General Practitioners on Chronic Kidney Disease in Beijing

目的了解北京市基层全科医生对慢性肾脏病(CKD)的认知情况,为CKD社区管理提供依据。方法于2016年1月,采用方便抽样法选取北京市7家社区卫生服务中心及其下属社区卫生服务站的全科医生293例。采用自行设计的调查问卷对其进行调查,问卷内容包括全科医生的基本情况和CKD相关知识两部分,其中CKD相关知识包括CKD基础知识[定义、诊断标准、肾小球滤过率(GFR)分期、高危因素、病因、临床表现、并发症]和CKD管理方面知识(筛查方法、血压控制水平、药物治疗、非药物治疗、转诊标准)。共发放问卷293份,回收有效问卷282份,有效回收率为96.2%。结果全科医生对CKD相关知识的总体知晓率为24.9%(843/3 384),其中对CKD基础知识的总体知晓率为24.9%(492/1 974),对CKD管理方面知识的总体知晓率为24.9%(351/1 410)。不同学历全科医生对CKD定义、诊断标准、高危因素、并发症、筛查方法、非药物治疗、转诊标准的知晓率间差异无统计学意义(P>0.05),而对GFR分期、病因、临床表现、血压控制水平、药物治疗的知晓率间差异有统计学意义(P<0.05)。不同职称全科医生对CKD定义、诊断标准、病因、临床表现、血压控制水平、药物治疗、转诊标准的知晓率间差异有统计学意义(P<0.05),而对GFR分期、高危因素、并发症、筛查方法、非药物治疗的知晓率间差异无统计学意义(P>0.05)。不同工作年限全科医生对CKD定义、诊断标准、GFR分期、高危因素、病因、并发症、非药物治疗、转诊标准的知晓率间差异无统计学意义(P>0.05),而对临床表现、筛查方法、血压控制水平、药物治疗的知晓率间差异有统计学意义(P<0.05)。结论北京市全科医生对CKD相关知识的掌握存在严重不足,应尽早建立CKD社区管理建议,加强全科医生培训,以利于CKD社区管理。

Objective To investigate the cognition of grass - roots general practitioners on chronic kidney disease （CKD）in Beijing and to provide basis for community management of CKD. Methods A total of 293 general practitioners were selected from 7 community health service centers and their subordinate community health service stations in Beijing in January 2016 by sampling method. The subjects were investigated with a self - designed questionnaire. The contents of the questionnaire included basic information of general practitioners and CKD - related knowledge,including the basic knowledge of CKD〔definition,diagnostic criteria,glomerular filtration rate （GFR）staging,high risk factors,etiology,clinical manifestations, concurrent symptoms of CKD〕,and knowledge of CKD management （screening method,level of blood pressure control,drug therapy,non - drug treatment,referral criteria）. A total of 293 questionnaires were sent out,and 282 valid questionnaires were collected. The effective response rate was 96. 2% . Results The overall awareness rate of CKD knowledge among general practitioners was 24. 9% （843 / 3384）,of which the overall awareness rate of basic knowledge of CKD was 24. 9% （492/ 1974）,and the overall awareness rate of CKD - management knowledge was 24. 9% （351 / 1410）. There were no significant differences in the awareness rate of CKD definition,diagnostic criteria,risk factors,complications,screening methods,non -drug treatment and referral criteria among general practitioners with different educational backgrounds （P 〉 0. 05）,while there were significant differences in the awareness rate of GFR staging,etiology,clinical manifestation,level of blood pressure control and drug treatment （P 〈 0. 05）. There were significant differences in the awareness rate of CKD definition,diagnostic criteria, etiology,clinical manifestation,level of blood pressure control,drug treatment and referral standard among general practitioners with different professional titles （P 〈 0. 05）,while there was no significant difference in their awareness rate of GFR staging, high risk factors,complications,screening methods and non - drug treatment （P 〉 0. 05）. There was no significant difference in the awareness rate of CKD definition,diagnostic criteria,GFR staging,high risk factors,etiology,complications,non - drug treatment and referral standard among general practitioners with different years of working （P 〉 0. 05 ）,while there was significant difference in their awareness rate of clinical manifestations,screening methods,level of blood pressure control and drug treatment （P 〈 0. 05）. Conclusion There are serious deficiencies in the mastery of CKD - related knowledge among general practitioners in Beijing. In order to facilitate the community management of CKD,the community management suggestion should be proposed as soon as possible and the training of general practitioners should be strengthened.