农村订单定向医学毕业生参与新型冠状病毒肺炎疫情防控情况研究

Cross-sectional Study of Target Admission General Practitioners'Participation in Combating COVID-19 Pandemic

背景新型冠状病毒肺炎(简称新冠肺炎)疫情防控期间,基层卫生工作者起到了十分重要的作用。我国于2010年发文启动实施农村订单定向医学生免费培养工作,从2015年起至今已有数届订单定向医学生完成了本科学业,其在疫情防控中的工作情况值得关注。目的调查订单定向毕业生和其他临床五年制毕业生参与新冠肺炎疫情防控工作情况,分析订单定向毕业生在疫情防控中发挥的作用及存在的困难与挑战,并提出针对性政策建议。方法本研究数据来源于“订单定向医学生队列研究”项目,本次随访调查于2020年9月采用电子问卷形式开展,有效随访我国中西部4所医学院校2015—2019届共1631例订单定向毕业生和1009例其他临床五年制毕业生,调查内容包括基本信息、基本工作情况、疫情期间工作情况等。结果在调查期间处于工作状态的毕业生中,订单定向毕业生的疫情防控工作参与率高于其他临床五年制毕业生〔70.18%(1113/1586)比51.58%(293/568),P<0.05〕。订单定向毕业生中,男性参与率高于女性(P<0.05),2015—2016届参与率高于2017—2019届(P<0.05),已婚者参与率高于未婚/离异/其他婚姻状况者(P<0.05)。在参与疫情防控工作的订单定向毕业生中,参与较多的服务类别为健康宣传与教育〔88.59%(986/1113)〕、社区防疫与管理〔85.62%(953/1113)〕、核酸检测与筛查〔67.30%(749/1113)〕,面临的常见挑战为缺少防护设备〔77.72%(865/1113)〕、工作量和/或工作压力太大〔41.87%(466/1113)〕、担心自己或家人被感染〔37.56%(418/1113)〕,认为疫情防控期间的日常临床工作量、日常公共卫生工作量增多的人员占比分别为57.50%(640/1113)和62.26%(693/1113)。结论订单定向毕业生在疫情防控过程中承担了多项重要工作,对全国的疫情防控发挥了不可忽视的作用,但是同时存在着防护设备不足、工作压力过大等问题。建议进一步改善基层卫生设施,为基层医务工作者提供更多的防护与支持。

Background Primary healthcare workers have played an important role in combating the COVID-19 pandemic.Beginning in 2010,China initiated a national policy of implementing the rural-oriented tuition-free medical education(RTME)program,aiming to train general practitioners(GPs)with a medical undergraduate degree to work in rural areas to address the shortage of rural physicians.Since 2015,many graduates with RTME returned to the contracted rural hospital to fulfill a 3-year obliged health services,and their performance in combating COVID-19 epidemic is worth to be concerned about.Objective To compare the participation and role of target admission GPs and other graduates trained with a five-year undergraduate degree program for clinical medical students in combating COVID-19 pandemic,and to analyze the duties and challenges for target admission GPs during the anti-pandemic period,then based on this,to put forward policy recommendations for incentivizing target admission GPs.Methods The data were sourced from the Target Admission Medical Students Cohort Study Program.We conducted a follow-up survey among 1631 target admission GPs and 1009 other clinical medical graduates graduating from 4 medical colleges in central and western China using an online questionnaire in September 2020.Basic demographics,job information and work status during the COVID-19 pandemic were collected.Results Among those who were employed in the study period,target admission GPs had a higher rate of participating in combating COVID-19 pandemic than other clinical medical graduates〔70.18%(1113/1586)vs 51.58%(293/568),P<0.05〕.Among target admission GPs,men had a higher rate of being involved in combating COVID-19 pandemic than women(P<0.05);those admitted in 2015 and 2016 had a higher rate of being involved in combating COVID-19 pandemic than those admitted during 2017 to 2019(P<0.05);and those who were married had a higher rate of being involved in combating COVID-19 pandemic than those who were unmarried/divorced/other marital status(P<0.05).The top 3 types of work which most target admission GPs participated were"health promotion and education"〔88.59%(986/1113)〕,"community epidemic prevention and management"〔85.62%(953/1113)〕,and"SARS-CoV-2 nucleic acid testing and screening"〔67.30%(749/1113)〕.The top three challenges most target admission GPs faced in combating COVID-19 pandemic were"lack of personal protective equipment"〔77.72%(865/1113)〕,"too much workload and/or pressure"〔41.87%(466/1113)〕,and"worrying about themselves and their family being infected"〔37.56%(418/1113)〕.The prevalence of target admission GPs who reported that there was an increase in daily clinical work was 57.50%(640/1113).And that of target admission GPs who reported that there was an increase in daily public health services was 62.26%(693/1113).Conclusion Target admission GPs have implemented multiple key services regarding COVID-19 containment,indicating that they have played a role in the national COVID-19 containment that cannot be ignored.However,they faced difficulties such as insufficient personal protective equipment and excessive work pressure.Measures need to be taken to improve the infrastructures in rural areas,and to provide more protection and support for primary healthcare workers.