新型冠状病毒肺炎疫情下基层医生自我角色定位与专家建议一致性及影响因素研究

Roles of Primary Care Doctors in COVID-19 Pandemic:Level of Consistency Across Perceptions of Doctors and Experts and Impact Factors

背景2019年底暴发了新型冠状病毒肺炎(COVID-19)疫情,基层医生作为基层疫情防控人员,其自我角色定位影响其对工作责任的认知,因此,了解基层医生角色定位及其影响因素十分必要。目的了解COVID-19疫情下基层医生自我角色定位与专家建议的一致性,为开展基层医生针对性培训、明确重大公共卫生事件下角色定位提供依据。方法2020年2月21—27日,通过问卷调查了解浙江省11个地级市的1758名基层医生COVID-19疫情下自我角色定位情况,包括是否应该进行传染性疾病的健康教育、确诊COVID-19并分型、上报及转诊疑似病例、治疗疑似或确诊病例、随访经过治疗的患者5个内容的角色定位,并与专家建议的疫情下基层医生角色定位比较,与专家建议一致率≥90%为一致率高。采用多因素Logistic回归分析基层医生自我角色定位与专家建议不一致的影响因素。结果1758名基层医生中,1513名(86.1%)基层医生参与一线抗疫,疫情下基层医生在参与传染病健康教育、上报或转诊疑似病例、随访经过治疗的患者的角色定位上与专家建议一致率高,分别是99.6%(1751/1758)、96.8%(1702/1758)、91.3%(1605/1758)。但在确诊COVID-19并分型、治疗疑似病例的基层医生角色定位上,与专家建议一致率低,分别是49.5%(871/1758)和61.4%(1080/1758)。Logistic回归分析结果显示,在确诊COVID-19并分型的角色定位上,工作在村卫生室或社区卫生服务站、中高级职称的基层医生在自我角色定位上更易与专家建议相一致(P<0.05);在治疗疑似病例的角色定位上,工作在村卫生室或社区卫生服务站、中高级职称、参与一线抗疫的基层医生在自我角色定位上更易与专家建议相一致(P<0.05)。结论疫情下,多数基层医生参与一线抗疫,基层医生在确诊COVID-19并分型和治疗疑似病例的角色定位上与专家建议一致率低,建议疫情下要针对低职称、社区服务中心或卫生院的非一线基层医生进行诊断及治疗上的功能支持和角色定位指导。

Background Primary doctors have participated in containing the COVID-19 pandemic outbroken in December 2019 at the primary level.Investigating their perception of their own roles in the pandemic containment and influencing factors is necessary,since their perceived roles have impact on their recognition of obligations.Objective To investigate the consistency of primary doctors and experts'perceptions of roles of primary doctors in COVID-19 containment,providing evidence for the development of targeted trainings for primary doctors and the determination of the roles of them in major public health events.Methods A questionnaire survey was conducted among 1758 primary care doctors from Zhejiang Province from February 21 to 27,2020 for investigating their perceptions of roles of primary care doctors in COVID-19 containment,including whether health education of infectious diseases should be conducted,the classification of COVID-19 and classification,reporting and referral of suspected cases,treatment of suspected or confirmed cases,follow-up of patients after treatment.The role positioning of primary care doctors was compared the consensus rate with expert recommendations,and the consistency rate was high when it was more than 90%.Multivariate Logistic regression was used to analyze the factors that the self-role orientation of primary care doctors was inconsistent with the expert's suggestion.Results Among 1758 participants,1513(86.1%)participated in the frontline containment of COVID-19 pandemic.Respondents and experts had highly identical perceptions on primary care doctors'roles in carrying out health education on infectious diseases〔99.6%(1751/1758)〕,reporting or referring suspected cases〔96.8%(1702/1758)〕and following-up of the treaded patients〔91.3%(1605/1758)〕,while they were at variance over diagnosing and classifying COVID-19〔49.5%(871/1758)〕as well as treating suspected cases〔61.4%(1080/1758)〕.Logistic regression analysis indicated that working at a clinic or health station,and intermediate or senior professional title were facilitators for respondents having similar perceptions on primary care doctors'roles in diagnosing and classifying COVID-19(P<0.05);working at a clinic or health station,intermediate or senior professional title,and participating in COVID-19 containment were facilitators for respondents having similar perceptions on treating suspected cases to those of experts(P<0.05).Conclusion Most primary care doctors have participated in frontline COVID-19 containment.Their perceptions of their roles over diagnosing and classifying COVID-19,and treating suspected cases are low consistent with those of experts.In view of this,functional support for diagnosing and treating COVID-19 and guidance on how to appropriately understand primary doctors'roles in COVID-19 containment should be given to primary doctors with junior professional title,less years of working as a doctor,working at the community(township)health center,or without an experience of containing COVID-19 at the frontline.