社区全科医生儿科临床适任能力培训效果评价及其对社区儿科门诊运行的影响研究

Evaluation of Pediatric Clinical Competency Training Program for Community General Practitioners and Its Impact on the Operation of Community Pediatric Clinic

背景目前我国儿科医疗的"供需矛盾"正逐渐凸显,全科儿科的发展是最有可能缓解儿科医疗资源紧张的突破口。在嘉定区,社区儿科服务能力明显不足。在此背景下,为了合理配置儿童医疗资源,解决常见病、多发病占用儿童专科医院资源的难题,2017年上海市嘉定区原卫生计生委开展了"全科医师儿科临床适任能力培训"项目。目的调查第一批"上海市嘉定区全科医师儿科临床适任能力培训"项目对该区13家社区卫生服务中心开展全科儿科门诊的影响。方法 2018年1—3月,采用自主设计问卷对14名参培"上海市嘉定区全科医师儿科临床适任能力培训"项目的全科医生和社区其余未参培的部分全科医生进行调查。问卷内容包括接受调查全科医生的基本情况、社区开展儿科门诊后的现状及全科医生对儿科培训的建议。结果共发放问卷207份,问卷全部有效回收,其中参培全科医生14名,未参培全科医生193名。50.0%(7/14)的参培全科医生认为自己能够胜任儿科门诊接诊,78.6%(11/14)能够掌握一些儿科常见危重症的急救处理,71.4%(10/14)认为已掌握了儿科用药规律。参培全科医生和未参培全科医生拟开展儿科诊疗的方式意愿、拟开展儿科门诊的时间意愿比较,差异有统计学意义(P<0.05)。社区儿科开展后,多数社区接诊量均小于5人次/半天。64.3%(9/14)的参培全科医生愿意参加更多儿科培训。结论参培全科医生认为参加培训后开展社区儿科门诊的能力有所提高,但当前实践中仍存在儿科接诊经验不足、儿科药物及检验缺乏、儿科门诊就诊量少等问题,需要进一步改进。

Background In China,the contradiction between supply and demand of pediatric services is increasingly prominent,and the development of general pediatrics may be the most likely breakthrough to alleviate the shortage of pediatric resources.In Jiading District,community hospitals were incapable to deliver pediatrics services to satisfy residents’needs.To rationally allocate pediatrics resources,and address the issue of too many resources used by common pediatric illnesses and frequently-occurring pediatric diseases in children’s hospitals,Jiading District Health and Family Planning Commission(now known as Jiading District Health Commission)has initiated Shanghai’s Jiading pediatric clinical competency training program for general practitioners(GPs)in 2017.Objective To investigate the influence of the implementation of Shanghai’s Jiading pediatric clinical competency training program for GPs for the first time on the operation of pediatric clinic in 13 community health centers(CHCs)in this district.Methods From January to March 2018,we conducted a survey with 14 GPs with an experience of attending Shanghai’s Jiading pediatric clinical competency training program for GPs and other GPs without from 13 CHCs.A self-designed 49-item questionnaire was used to collect the general personal data,status of the operation of community pediatric clinic and suggestions for pediatric training.Results All the 207 cases participating in the survey handed in responsive questionnaires including 14 trained GPs and 193 untrained GPs.Among the trained GPs,50.0%(7/14)reported that they were capable to deliver pediatric outpatient services,78.6%(11/14)reported that they could master the emergency treatment of some common critical pediatric diseases,and 71.4%(10/14)believed that they had mastered the rules in pediatric drug therapies.Compared with untrained GPs,the willingness of trained GPs to carry out pediatric diagnosis and treatment and carry out pediatric outpatient service time were different(P<0.05).A few months of operating a pediatric clinic showed that the visits for the clinic in most CHCs were less than 5 in half a day.64.3%(9/14)of the GPs were willing to participate in more pediatric trainings.Conclusion The trained GPs thought that their competencies for delivering outpatient pediatric services were increased by training,but they had insufficient experience in pediatric consultations.Further improvement will be needed in introducing more pediatric medicines,increasing pediatric laboratory testing programs and promoting more clinical visits.