上海市提升基层儿科服务能力政策实施效果分析研究

Analysis and research of the implementation effect of policies to improve the service capability of basic-level pediatrics in Shanghai

目的:分析提升基层儿科服务能力的相关政策出台后,社区儿科服务开展现状和存在问题。方法:于2019年5—7月选取上海市245家社区卫生服务中心的主任/副主任作为调查对象,分别对其进行问卷调查,共发放245份问卷,回收有效问卷245份,问卷有效回收率100.0%。于2019年8月采取整群抽样方法从已开展儿科诊疗服务的111家社区卫生服务中心中抽取4家,从未开展儿科诊疗服务的134家社区卫生服务中心中抽取4家,对这8家社区卫生服务中心的10名主任/副主任进行半结构式访谈。结果:截至2018年年底,上海市开展儿科诊疗服务的社区卫生服务中心为111家,共有84家社区卫生服务中心加入儿科医疗联合体。自2016年起上海市共举办5期社区全科医生儿科能力专项培训,获得合格证书的学员为1443名,其中369名(25.6%)学员经培训合格后在社区卫生服务中心开展儿科诊疗服务。访谈结果显示,社区医生缺乏临床诊疗经验、儿科基本药物配备不齐全、儿科诊疗相关技术支持有待完善、儿科医疗联合体互联互通有待加强和社区居民认可度较低等为基层开展儿科诊疗服务面临的主要问题。结论:建议对我国基层全科医生和儿科医生加强以下几方面培训:(1)在住院医师规范化培训中增加儿科技能培训内容;(2)进一步加强全科医生和儿科医生的在职儿科技能相关培训;(3)定期委派全科医生和儿科医生到上级医疗机构儿科进行进修学习。

Objective:To analyze the current situation and existing problems of community pediatric service after the introduction of relevant policies to improve the primary pediatric service ability.Methods:The directors/deputy directors of 245 community health service centers in Shanghai were selected as respondents from May to July 2019,and subjected to a questionnaire survey.A total of 245 questionnaires were sent out,and 245 questionnaires were received with effective recovery rate of 100.0%.In August 2019,cluster sampling method was adopted to select 4 out of 111 community health service centers that had carried out pediatric diagnosis and treatment services,and four out of 134 community health service centers that never provided pediatric diagnosis and treatment services were selected,and semi structured interviews were conducted with 10 directors/deputy directors of these 8 community health service centers.Results:By the end of 2018,there were 111 community health service centers in Shanghai carrying out pediatric diagnosis and treatment services,and 84 community health service centers joined the pediatric medical union.Since 2016,Shanghai had held 5 special training sessions for pediatric competence of general practitioners,and 1443 general practitioners obtained certificates,among whom 369(25.6%)general practitioners carried out pediatric services in community health service centers after passing the training.The interview results showed that community doctors lacked the clinical experience in pediatric diagnosis and treatment,pediatric essential drugs were not fully equipped,pediatric diagnosis and treatment technology support needed to be improved,pediatric medical union connectivity needed to be strengthened and community residents’recognition was low,which were the main problems facing the basic pediatric diagnosis and treatment services.Conclusion:It is suggested to strengthen the training of primary pediatricians and general practitioners in China in the following aspects:(1)to increase the training content of pediatric skills in the standardized training of residents;(2)to further strengthen in-service pediatric skills training for general practitioners and pediatricians;(3)to regularly appoint general practitioners and pediatricians to the department of pediatrics in higher-level medical institutions for further study.