上海市社区全科医生循证医学实践现状的定性访谈研究

A Qualitative Interview Study on the Current Status of Evidence-based Medicine Practice among Com⁃munity General Practitioners in Shanghai

为了了解上海市区全科医生循证医学的实践情况,为完善全科医生培养方案和提高基层医疗服务质量提供参考。2021年12月至2022年2月,采用目的抽样的方法对上海市10个社区的40名全科医生进行定性研究。访谈内容包括循证医学的概念、循证医学专业知识来源、循证医学实践中遇到的困难。仅20%的全科医生能完整地回答出循证医学的概念。临床工作中主要的循证医学知识来源为教科书、临床实践指南、互联网和微信公众号。全科医生缺乏效能感和循证医学培训,患者信任程度及依从性较差、社区卫生服务中心文献信息获取困难、科室缺乏科研氛围等是全科医生循证实践过程中遇到的主要困难。上海市全科医生对循证医学概念掌握得尚不理想,部分医生仍通过非循证的手段来获取所需信息,全科医生在循证实践过程中存在一些困难。相应的制度和策略应进一步完善,以帮助循证医学在基层医院应用。

Objective:To understand the practice of evidence-based medicine among general practitioners in Shanghai and provide reference for improving general practitioner training programs and improving the quality of primary medical services.Methods:From December 2021 to February 2022,a qualitative study was conducted on 40 general practitioners in 10 communities of Shanghai using purposive sampling.The interview content included the concept of evidence-based medicine,the sources of professional knowledge of evidence-based medicine,and the difficulties encountered in the practice of evidence-based medicine.Results:Only 20%of general practitio-ners could fully answer the concept of evidence-based medicine.The important sources of evidence-based medi-cal knowledge in clinical work are textbooks,clinical practice guidelines,Internet searches,and WeChat public accounts.General practitioners’lack of efficacy and training in evidence-based medicine,poor patient trust and compliance,difficulty in obtaining literature information from community health service centers,and lack of scien-tific research atmosphere in departments are the main difficulties encountered by general practitioners in the pro-cess of evidence-based practice.Conclusion:General practitioners in Shanghai still do not have a satisfactory grasp of the concept of evidence-based medicine.Some doctors still obtain the required information through non-evidence-based means.General practitioners have some difficulties in the process of evidence-based practice.Corresponding systems and strategies should be further improved to help the application of evidence-based medi-cine in primary hospitals.