贵阳市社区医院慢性疼痛诊疗现状及患者满意度调查

Investigation of the Current Situation of Diagnosis and Treatment of Chronic Pains and the Patients’ Satisfaction in Community Hospitals in Guiyang

目的:了解贵阳市社区医院慢性疼痛诊疗现状及患者满意度。方法:抽取贵阳市城区和郊县社区医院45个,对社区医院负责人进行现场问卷调查,收集45个社区医院的慢性疼痛诊疗医师人数、职称、参与培训次数、建立独立疼痛门诊及病房情况和诊疗措施;分别选择某社区医院疼痛科和某三甲医院疼痛科慢性疼痛出院患者作为社区组(n=45)和三甲组(n=120),电话随访收集患者的一般情况(性别、年龄、病程)、入院时和出院时疼痛程度(NRS)评分、出院时对诊疗水平的满意度。结果:45个社区医院中开展了疼痛独立门诊的有4个(95%CI为1.00~10.20),建立疼痛门诊疼痛病房的社区医院1个(95%CI为0.10~5.60),开展神经阻滞治疗的社区医院为11个(95%CI为5.40~19.70);参与慢性疼痛诊疗的医师125人,平均每个医院(2.78±1.22)人(95%CI为2.41~3.15),主治医师及以上职称6人(95%CI为2.20~13.10),每年参与慢性疼痛诊疗学习班21人次(95%CI为13.00~32.00);2组慢性疼痛患者治疗后NRS评分均明显低于治疗前,社区组患者治疗后NRS评分明显高于三甲组,社区组患者对社区医院诊疗满意度(8.89%)明显低于三甲组(95.83%),差异均有高度统计学意义(P<0.01)。结论:贵阳市社区医院慢性疼痛的诊疗能力亟待加强,慢性疼痛患者对社区医院诊疗工作的满意度较低。

Objective:To investigate the current situation of diagnosis and treatment of chronic pains and patients'satisfaction in the community hospitals in Guiyany China,and to provide a scientific basis for the diagnosis and treatment of chronic pains.Methods:55 community hospitals in Guiyang City were randomly selected.Self-made questionnaires were used for face-to-face investigation of the doctors of 45 community hospitals.The questionnaires included the number of doctors engaged in chronic pain diagnosis and treatment,their professional titles,the number of training trips,the number of established independent pain management clinics and wards,and the diagnosis and treatment measures provided to patients with chronic pains.The discharged patients with chronic pains were collected and the pain management department of Grade-A tertiary hospitals from January to July 2018.According to the self-made satisfaction questionnaires,the satisfaction of discharged patients were followed up by telephone,and the satisfaction of patients with community hospitals and first-class hospitals at grade 3 was statistical analysis byχ2 test.Results:Out of the 45 sample community hospitals,there were 4 community hospitals with independent pain clinics(95%CI was 1.00~10.20),1 community hospital with pain wards(95%CI was 0.10~5.60),accounting for only 2.22%.125 doctors participated in the diagnosis and treatment of chronic pains,with an average of 2.78±1.22 in each hospital(95%CI was 2.41~3.15);6 doctors with intermediate and above professional titles(95%CI was 2.20~13.10);21 attending classes of chronic pain diagnosis and treatment each year(95%CI was 13.00~32.00);11 community hospitals were engaged in nerve block for chronic pain treatment(95%CI was 5.40~19.70);none of the community hospitals carried out intervention operation for chronic pains(95%CI was 0.00~3.70).The patients'satisfaction of community hospitals(8.89%)was obviously lower than that of grade-A tertiary hospitals(95.83%).The difference was statistically significant(P<0.05).Conclusion:At present,most community hospitals in Guiyang have no independent pain clinics and wards,the number of doctors engaged in chronic pain treatment is small,and they lack training;the doctors'professional titles are rather low;the technology of nerve block and interventional operation is less developed;The satisfaction of patients with chronic pains in community hospitals of Guiyang city is rather low.The chronic pain diagnosis and treatment of Guiyang community hospital needs to be urgently improved.