《基层医疗卫生机构改善医疗服务措施》实施后北京市密云区社区卫生服务中心慢性阻塞性肺疾病管理情况调查

Status quo of chronic obstructive pulmonary disease management in primary care health institutions of Beijing Miyun District after the Measures to Improve Medical Services in Primary Medical and Health Institutions

目的:通过对北京市密云区社区卫生服务中心的负责人及全科医生进行问卷调查,探讨2019年6月北京市发布的《基层医疗卫生机构改善医疗服务措施》(简称“措施”)实施后基层医疗卫生机构慢性阻塞性肺疾病(简称“慢阻肺”)的管理现状。方法:2020年8月11—21日,采用自主设计的调查问卷,选取北京市密云区全部19家社区卫生服务中心(简称“中心”)及来自4家推荐中心的61名全科医生为研究对象进行问卷调查。问卷包括《医疗机构现况调查问卷》(简称“机构问卷”)和《全科医生慢性呼吸疾病知识问卷》(简称“医生问卷”)。机构问卷由密云区卫生健康委员会(卫健委)组织发放,中心负责人填写;医生问卷由密云区卫健委推荐4家中心,发放问卷二维码,全科医生自愿扫描填写。采用描述性分析及相关统计学检验方法对调查问卷结果进行分析。结果:回收有效机构问卷19份。其中,措施实施后12家中心配备了肺功能检查设备;17家中心配备了吸入性糖皮质激素/长效β2受体激动剂(ICS/LABA);12家中心开展了慢阻肺家庭医生签约管理,自填表日回溯1年共签约患者267例,7家中心对已签约患者进行每年≥2次的随访;13家中心向医联体北京市密云区医院转诊,转诊2024例次/年。医生问卷有效回收率100%(61/61),20%(12/61)的全科医生进行了慢阻肺患者签约管理,20%(12/61)的全科医生曾转诊慢阻肺患者至二、三级医院,转诊主要原因为因确诊或随访需求或条件所限,患者需要做肺功能等检查;61名全科医生慢阻肺相关知识答题得分为(58.9±20.0)分,与2018年来自相同4家中心的65名全科医生的慢阻肺相关知识答题得分[(63.2±18.9)分]比较,差异无统计学意义(t=0.456,P>0.05)。结论:措施的实施促进了北京市社区慢阻肺的规范化管理及基础设施的完善,带动基层医疗卫生机构与二、三级医疗机构的工作对接,但仍需加强基层全科医生相关知识和技能的能力培训,提升其对慢阻肺患者的管理能力。

Objective To investigate the status quo of the management of chronic obstructive pulmonary disease(COPD)in primary care health institutions in Miyun District of Beijing.Methods The Measures to Improve Medical Services in Primary Medical and Health Institutions was issued by Beijing Municipal Health Commission in June 2019.In August 2020,a survey on COPD management status after the measures was conducted with self-designed questionnaire among 19 community health service centers and 61 general practitioners(GPs)from 4 centers in Miyun District of Beijing.Two questionnaires were used for the survey:one was on the status of medical institutions(institution questionnaire,filled by the person in charge of the center)and other was on COPD knowledge of general practitioners(doctor questionnaire,filled by selected GPs).Results For health institution,19 valid questionnaires were collected.Among them,12 centers were equipped with lung function examination equipment after reform;17 centers were equipped with inhaled corticosteroids/long actingβ2 receptor agonists(ICS/LABA);12 centers carried out the contract management of family doctors for COPD;267 patients signed the contract,7 centers followed up the signed patients at least twice a year;13 centers referred patients to Miyun District Hospital with 2024 referrals per year.For GPs,61 valid questionnaire were collected with a recovery rate of 100%(61/61).Among them 12 GPs(20%)had contracted management for COPD patients;12 GPs(20%)had referred COPD patients to the secondary or tertiary hospitals;and 9/12 of GPs referred the patients for lung function examination due to the needs of diagnosis or follow-up.The mean COPD-related knowledge score was(58.9±20.0),compared with the score of 65 GPs from the 4 same community centers tested in 2018(63.2±18.9),there was no significant difference(t=0.456,P>0.05).Conclusions The implementation of the primary care institution measures in Beijing promoted the management of COPD and improved capacity building in primary health institutions,also promoted the work docking between primary health institutions and secondary,tertiary hospitals.However,it is still necessary to strengthen the ability training of general practitioners in relevant knowledge and skills to improve their management ability of COPD.