基层治理视角下乡村医生疫情防控职责的实证研究

Rural Physicians'Duties and Responsibilities in COVID-19 Pandemic Containment:an Empirical Study from the Perspective of Governance in Primary Care

背景基层疫情防控是我国疫情防控的第一道防线,也是国家应对突发公共卫生事件体系的重要组成部分,乡村医生作为村民健康的“守门人”在农村疫情防控中发挥着重要作用。但目前乡村医生在履行疫情防控职责过程中存在不少问题,影响了其作用的发挥。目的调查乡村医生在农村疫情防控中承担的职责,探讨其中存在的问题,并提出相应的建议。方法2021年4—7月,以北京市怀柔区为现场组织开展此次调研活动,对村落进行非参与式观察和利益相关者的半结构化访谈,以信息饱和为原则,访谈对象为样本村的18例乡村医生。在广泛查阅文献资料和咨询专家意见的基础上,编制出访谈提纲,内容包括:(1)乡村医生基本个人情况(包括执业地点、性别、年龄),(2)乡村医生从业资质(包括乡村医生学历、执业起始时间和执业资质),(3)疫情防控工作参与情况(包括“村卫生室疫情防控十须知”知晓情况、疫情防控参与情况以及疫情防控物资拥有情况)。结果18例乡村医生中,14例(77.8%)有乡村医生证书,3例(16.7%)有乡村全科助理医师证书,2例(11.1%)有执业医师证书,1例(15.6%)有执业助理医师证书。17例(94.4%)乡村医生表示知晓“村卫生室疫情防控十须知”,1例(5.6%)不知晓该须知。参与度前三位的疫情防控工作内容分别是健康宣教(94.4%)、信息报送(72.2%)和诊疗工作(66.7%);参与最少的工作是咽拭子采样,仅有1例(5.6%);参与其他疫情防控工作的有3例,工作内容为村中人员排查、指导村中疫情防控工作和为村民采购食品。疫情防控一级响应期间,仅有10例(55.6%)乡村医生表示疫情防控物资充足,8例(44.4%)表示疫情防控物资不足;在疫情防控常态化期间,16例(88.9%)表示疫情防控物资充足,2例(11.1%)表示疫情防控物资仍不充足。疫情防控常态化期间前4位的疫情防控物资分别是84消毒液(72.2%)、普通一次性医用口罩(66.7%)、一次性手套(66.7%)和医用外科口罩(61.1%),拥有最少的疫情防控物资是医用防护服(38.9%)和护目镜(11.1%)。结论农村地区的疫情防控离不开乡村医生,但目前存在乡村医生疫情防控能力有限、参与居家隔离监测缺乏法律明确授权、提供咽拭子采样服务超出其能力范围以及防护物资缺乏等困境。建议完善相关法律法规,为乡村医生疫情防控职责提供法律依据,将乡村医生纳入村委会公共卫生委员会的队伍中,同时,保障乡村医生疫情防控物资供给,助力乡村医生发挥职能。

Background COVID-19 pandemic containment in rural areas is the frontline for containing COVID-19 and a key part of response system for public health emergencies in China,during which rural physicians play an important role as the“gatekeeper”of rural residents'health and rural pandemic prevention and control.However,rural physicians have demonstrated some work-related problems during the COVID-19 pandemic containment,which have affected the implementation effectiveness of their duties and responsibilities.Objective To investigate the duties and responsibilities of rural physicians during COVID-19 pandemic containment in rural areas,and to identify the problems,then put forward relevant suggestions.Methods An on-site semi-structured interview using non-participant observation approach was carried out in Beijing's Huairou District from April to July,2021.Eighteen rural physicians were selected to attend the interview as stakeholders.The interview was guided by an outline developed based on a literature review and an expert consultation,including three parts:(1)demographic characteristics(practice location,sex,age),(2)practicing qualifications(education level,starting time of practicing,professional qualifications),(3)involvement in COVID-19 pandemic prevention and control(awareness of the 10 instructions for COVID-19 pandemic containment in village clinics,participation in COVID-19 pandemic containment,and personal protective equipment materials for COVID-19).The interview was continued until data saturation.Results Among the 18 rural physicians,14(77.8%)were certified as rural physicians,3(16.7%)were certified as rural assistant general practitioners,2(11.1%)had a certificate of licensed physician and 1(5.6%)had a certificate of licensed assistant physician.Except for one(5.6%),the rural physicians〔17(94.4%)〕indicated that they knew the 10 instructions for COVID-19 pandemic containment in the village clinic.The top three services about COVID-19 pandemic containment most frequently provided by the rural physicians were health education(94.4%),information reporting(72.2%)and diagnosis and treatment(64.7%),and the least provided was throat swab sampling〔only one case(5.6%)〕.In addition,three rural physicians participated in providing other services,which included screening suspected COVID-19 cases in the village,guiding COVID-19 pandemic containment in the village,and purchasing food for villagers.Ten physicians(55.6%)indicated that personal protective equipment materials for COVID-19 were adequate,but other 8(44.4%)expressed that such materials were inadequate during the first response phase.During the regular COVID-19 pandemic containment phase,16 physicians(88.9%)indicated that personal protective equipment materials for COVID-19 were adequate,but other 2(11.1%)still indicated that such materials were inadequate.The top four personal protective equipment materials for COVID-19 owned by the physicians in regular COVID-19 pandemic containment phase were 84 Disinfectant(72.2%),ordinary disposable medical masks(66.7%),disposable gloves(66.7%)and medical surgical masks(61.1%),and the least owned were medical protective clothing(38.9%)and goggles(11.1%).Conclusion Rural physicians play a necessary role in COVID-19 pandemic containment in rural areas,but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19 pandemic containment services(including pharyngeal swab sampling),lack of a legal right to provide home-based isolation and monitoring services,and inadequate personal protective equipment materials.Therefore,it is recommended that relevant laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in COVID-19 pandemic containment,recruit them to the public health team of the village committee,and ensure the provision of emergency materials for village physicians to help them to realize their potential in pandemic containment.