医联体模式对基层医生幽门螺杆菌感染规范化诊治的干预效果研究

Impact of medical conjoined mode on standardized diagnosis and treatment of Helicobacter pylori infection by primary doctors

背景幽门螺杆菌(Helicobacter pylori,H.pylori)与慢性胃炎、消化性溃疡和胃癌关系密切.多数H.pylori感染者首诊于社区卫生服务中心等基层医疗卫生机构,而当前基层医生在H.pylori感染诊治过程中存在一些不规范之处.本研究通过医共体模式对基层医生进行规范化管理和培训,提高了基层医生H.pylori规范化诊疗水平.目的观察医联体模式对基层医生H.pylori感染规范化诊治的干预效果.方法选取我院所辖5家社区服务中心的基层医生112人,在6 mo内分批对其进行为期3 d的H.pylori感染规范化诊治轮训,比较轮训前后基层医生对《第五次全国幽门螺杆菌感染处理共识》的掌握情况.结果共有106名基层医生完成模块化培训及问卷调查.培训前,基层医生对《第五次共识》的了解较为薄弱,在诊治工作中没有完全应用《第五次共识》;培训后,基层医生对《第五次共识》的知晓和接受程度较培训前明显提高(P<0.01,P<0.05).其中,88.24%的学员认为培训非常有必要,87.25%的学员认为培训效果非常好,95.10%的学员认同该培训模式.结论基层医生对《第五次共识》的依从性低,H.pylori感染诊治欠规范,医联体模式可明显提高基层医生对《第五次共识》的知晓、接受程度,较好的提高了H.pylori诊疗知识水平.

BACKGROUND Helicobacter pylori(H.pylori)infection has close relationship with chronic nonerosive gastritis,peptic ulcer,and gastritc cancer.The great majority of patients with H.pylori infection first visit grass-root health centers,where the diagnostic and therapeutic procedure of H.pylori infection is not standard.This study aimed to enhance the levels of diagnosis and treatment of H.pylori infection by standardized management and training of grassroots doctors under medical conjoined mode.AIM To investigate the effect of medical conjoined mode on the standardized diagnosis and treatment of H.pylori infection by primary doctors.METHODS Totally 112 primary doctors at our hospital and associated community service centers were selected.The primary doctors received a 3-d rotation training about the standar-dized diagnosis and treatment of H.pylori infection within 6 mo.The understanding and application of the Fifth Chinese National Consensus on the Management of H.pylori Infection(Fifth Consensus)among the primary doctors were compared before and after the training.RESULTS A total of 106 primary doctors completed the rotation training and questionnaire survey.The understanding and application of the Fifth Consensus among the primary doctors were poor before training.The Fifth Consensus has not been fully applied to the clinical diagnosis and treatment by primary doctors.After intervention,the understanding and application of the Fifth Consensus among the primary doctors were significantly improved compared with those before intervention(P<0.01 and P<0.05,respectively).About 88.24%of the primary doctors thought that the training was extremely essential,87.25%considered that the result of the training was fairly satisfactory,and 95.10%approved the training model.CONCLUSION The primary doctors have low compliance to the Fifth Consensus,and their diagnosis and treatment of H.pylori infection are nonstandard.The medical conjoined mode can improve the understanding of the Fifth Consensus among primary doctors and enhance their levels of diagnosis and treatment of H.pylori infection.