进修实习对基层医生医疗服务质量的影响分析

Analysis on influence of advanced study and practice on quality of medical services for primary doctors

目的探究进修实习对基层医生医疗服务质量的影响,为完善相关政策和提高服务质量提供参考。方法采用分层随机抽样法,选取432名基层医生,完成529个病例测试,运用临床情景知识法和标准化病人法对基层医生的知识水平和实际诊疗行为表现进行测量。结果多元线性OLS回归分析结果显示,运用临床情景知识法发现,基层医生问诊和检查个数(t=2.31)、比例(t=2.59)均有所提高,差异有统计学意义(P<0.05);运用标准化病人法发现,基层医生问诊和检查个数(t=0.13)、比例(t=0.49)均无提高,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,运用临床情景知识法,基层医生诊断正确性无提高(OR=0.815,P>0.05),但治疗合适性有所提高(OR=2.100,P<0.05);运用标准化病人法发现,医生诊断正确性(OR=0.930)、治疗合适性(OR=0.597)均无提高(P>0.05)。结论基层医疗服务质量有待进一步提高,进修实习可以显著提高基层医生的知识水平,但对医生的实际诊疗行为表现无显著影响。

Objective To explore the influence of advanced study and practice on the quality of medical services of primary doctors,so as to provide empirical reference for improving the policy of advanced study and practice of primary doctors and improving the quality of medical services of primary doctors.Methods Stratified random sampling method was used to select 432 primary doctors,and 529 tested cases were completed.Clinical situational knowledge method and standardized patient method were used to measure the knowledge level and actual diagnosis and treatment behaviors of primary doctors.Results The results of multivariate linear OLS regression analysis showed that the number of consultations and examinations(t=2.31)and the proportion(t=2.59)of primary doctors were improved by using the method of clinical situational knowledge,and the difference was statistically significant(P<0.05);by using standardized patient method,it was found that the number of consultations and examinations(t=0.13)and the proportion(t=0.49)of primary doctors were not improved,and the difference was not statistically significant(P>0.05).The results of multivariate logistic regression analysis showed that the diagnostic accuracy of primary doctors was not improved(OR=0.815,P>0.05),but the suitability of treatment was improved(OR=2.100,P<0.05)by using clinical situational knowledge method;by using standardized patient method,it was found that the accuracy of diagnosis(OR=0.930)and the suitability of treatment(OR=0.597)were not improved(P>0.05).Conclusion The quality of primary medical services needs further improvement.Advanced study and practice can significantly improve the knowledge level of primary doctors,but it has no significant effects on the improvement of doctors’actual diagnosis and treatment behaviors.