全科医生视角下影响社区医疗机构开展体医融合服务的质性研究

Qualitative Research on Factors Influencing the Implementation of Integrated Health Services in Community Medical Institutions from the Perspective of Practitioners

背景体医融合是推动社区居民健康的基础环节,也是助力社区医疗服务高质量发展的重要保障,而全科医生又是践行体医融合服务的落脚点与着力点,但目前缺乏基于全科医生视角的影响社区医疗机构开展体医融合服务的相关研究。目的研究全科医生对影响社区开展体医融合服务的理解和看法,旨在为社区更好地开展体医融合服务工作提供思路和参考。方法于2023年3—4月,通过目的抽样法,在湖南省株洲市选取5家社区卫生服务中心(站)的11名全科医生作为调查对象,利用“一对一”半结构化深度访谈的研究方法,借助内容分析软件Nvivo 12.0对访谈内容进行录音文本转录、分析单元形成、内容编码以及主题提炼。最后利用描述现象学分析法对访谈资料进行逻辑分析,掌握全科医生对影响社区开展体医融合服务的理解和看法,并归纳总结出访谈主题。结果影响社区开展体医融合服务的内容可归纳为4个主题和10个亚主题:体医融合服务环境亟待优化(场地供给不足、氛围滞后、宣传不足)、全科医生能力亟待提高(体医融合认知能力不足、开具运动处方能力缺乏)、社区卫生服务机构支持乏力(体医融合相关培训活动匮乏、经费划拨不足、人力资源短缺)、患者对体医融合服务认知不足(患者对体医融合疗效认知不足、患者对体医融合风险认知不够)。结论社区全科医生在体医融合服务能力方面还存在诸多不足,为了促进社区体医融合服务更好地发展,亟须优化社区体医融合服务环境;提高全科医生体医融合认知能力与开具运动处方能力;加强社区卫生服务机构支持保障力度;提升患者对体医融合服务的疗效和风险认知。

Background Physical and medical integration is essential for promoting the health of community residents and is an important guarantee for the high-quality development of community medical services,and practitioners are the foothold and focus of physical medicine integration services.However,there is currently a lack of relevant research on the impact of community medical institutions in carrying out physical medicine integration services from the perspective of practitioners.Objective To study the understanding and views of practitioners on how to carry out the integrated service of physical medicine in the community to provide ideas and references for the community to better carry out the integrated service of physical medicine.Methods In March and April 2023,11 practitioners from 5 community health service centers in Zhuzhou city,Hunan Province,were selected as survey subjects by means of an objective sampling method.The descriptive research method was adopted to conduct"one-on-one"semistructured in-depth interviews with community practitioners.With the help of the content analysis software Nvivo 12.0,text transcription recording,analysis unit formation,content coding and theme extraction were carried out for the interview content.Finally,the interview data were logically analyzed using descriptive phenomenological analysis to capture GPs'understanding and perceptions of the influences on the development of body-health integration services in the community,and to summarize the themes of the interviews.Results The factors affecting the development of physical and medical integration services in communities can be summarized into 4 themes and 10 subthemes.There was an urgent need to optimize the service environment for the integration of physical medicine(insufficient site supply,lagging atmosphere,and insufficient publicity),improve the ability of practitioners(insufficient cognitive ability for the integration of physical medicine and the ability to issue sports prescriptions),lack of support in community hospitals(lack of training activities related to the integration of physical medicine,insufficient fund allocation and shortage of human resources),and lack of patient cognition of the integration of physical and medicine(patients have poor cognition of the efficacy of body-medicine integration,and patients have poor cognition of the risk of body-medicine integration).Conclusion There are still many shortcomings in the service ability of community practitioners.To promote better development of community integrated services,it is urgent to optimize the service environment of community integrated services,to improve practitioners'integrative cognition ability and exercise prescription ability,to strengthen the support and guarantee of community health service institutions,and to improve patients'awareness of the efficacy and risk of physical and medical integration services.