西安市社区全科医生提供儿童普通感冒诊疗预防服务现状调查与分析

Diagnosis,Treatment and Prevention Services for Common Cold in Children Provided by General Practitioners in Xi'an:a Survey Analysis

背景儿童普通感冒的首诊工作应当交由社区卫生服务中心承担,然而目前社区卫生服务中心关于该病的不规范治疗以及过度治疗相当普遍。目的调查西安市社区全科医生针对儿童普通感冒提供的诊疗预防服务现状,分析并讨论相关诊疗不规范问题。方法 2017年2—3月选取在西安市城六区的49家社区卫生服务中心从事全科医疗工作(服务对象包含儿童)的全科医生121名为调查对象。采用自行设计的调查问卷对其进行调查,问卷内容包括一般资料以及目前社区全科医生针对儿童普通感冒提供的诊疗预防服务情况。结果共发放问卷121份,回收有效问卷118份,有效回收率为97.5%。62.7%(74/118)的全科医生认为儿童普通感冒虽然是一种自限性疾病,但充分对症治疗可以有效减轻症状、改善生活质量,若病情加重应及时就医;46.6%(55/118)的全科医生会常规给予患儿抗病毒药物(包括中成药),21.2%(25/118)会使用地塞米松作为儿童退烧药物(静脉滴注或雾化吸入给药);14.4%(17/118)的全科医生会满足患儿家属主动要求开具抗菌药物处方的要求,85.6%(101/118)会拒绝患儿家属主动要求开具抗菌药物处方的要求,其中98.0%(99/101)会进一步对患儿家属进行教育,以提高其对普通感冒的认知。90.7%(107/118)的全科医生有时或经常向患儿家属宣教儿童普通感冒无需抗菌药物治疗;9.3%(11/118)很少或从不向患儿家属宣教儿童普通感冒无需抗菌药物治疗。57.6%(68/118)的全科医生肯定了宣教的有效性,42.4%(50/118)不确定宣教的有效性或者认为宣教无效。68.7%(81/118)的全科医生经常向患儿家属宣教有关儿童普通感冒的预防知识,27.1%(32/118)有时会宣教,4.2%(5/118)很少会宣教,无人从不宣教。结论目前西安市社区全科医生提供的儿童普通感冒诊疗预防服务存在着很多不足,近40%的全科医生治疗理念不正确;部分临床不合理用药情况严重,如抗病毒药物、地塞米松药物的使用存在滥用情况;部分全科医生积极宣教但缺乏效果。针对这些情况,应尽快完善基层儿童普通感冒临床诊疗规范的制定和应用普及,加强全科医学继续教育,从而提高基层诊疗服务水平,加强儿童用药安全。

Background Community health centers(CHCs)are often the first medical institution that support children with common cold.However,it has been found that nonstandardized treatment and overtreatment of the disease are quite common in CHCs.Objective To investigate the diagnosis,treatment and prevention services for common cold in children provided by community general practitioners(GPs)in Xi’an,and analyze the issues related to nonstandardized diagnosis and treatment of the disease.Methods From February to March 2017,a total of 121 community GPs(delivering primary care to all populations)were selected from 49 CHCs in six urban districts of Xi’an City.They were surveyed with a self-designed questionnaire consisting of general demographic data and diagnosis,treatment and prevention services provided by community GPs for common cold in children.Results Of the 121 questionnaires distributed,118 were returned after being completed effectively,achieving a response rate of 97.5%.Of the 118 respondents,74(62.7%)believed that although common cold in children is a self-limited disease,adequate symptomatic treatment can effectively reduce symptoms and improve the quality of life,and timely medical consultation is necessary if the conditions become aggravated.In terms of treating the disease,46.6%(55/118)of the respondents reported that they generally prescribed antiviral drugs(including Chinese herbal preparations),21.2%(25/118)used dexamethasone via intravenous drip or atomized inhalation for the management of fever signs and symptoms;14.4%(17/118)prescribed antibacterials according to the requirement of the child’s family members;85.6%(101/118)rejected to prescribe antibacterials,despite of the requirement of the child’s family members,and 98.0%(99/101)of them explained the reasons to the child’s family members,in order to increase their awareness of common cold in children.With regard to the knowledge of antibacterial drug therapy for common cold,90.7%(107/118)reported that they sometimes or often taught the child’s family members the needlessness of antibacterial drug therapy to common cold,but 9.3%(11/118)rarely or never did so.90.7%(107/118)of the respondents approved the effectiveness of such health education,while 42.4%(50/118)were uncertain of the effectiveness of such education or thought that it was ineffective.In respective of the knowledge of preventing common cold,68.7%(81/118)reported that they frequently taught the child’s family members such knowledge,27.1%(32/118)sometimes did this,4.2%(5/118)seldom did this,but no one never did this.Conclusion There were inadequacies in the diagnosis,treatment and prevention services provided by community GPs in Xi’an:nearly 40% of the GPs held incorrect therapeutic concept;irrational drug use was severe in some CHCs,such as abuse of antiviral drugs and dexamethasone;some community GPs positively publicized knowledge about the treatment and prevention of common cold in children but the results were proved to be ineffective generally.In view of this,the capabilities of primary care practices should be improved by formulating and applying the standards for clinical diagnosis and treatment in primary care as soon as possible,strengthening the continuing education for GPs and enhancing the safety of drug use in children.