上海市社区全科医生对未分化疾病认知度和诊疗能力的自我评价研究

doi:10.12114/j.issn.1007-9572.2021.00.304

摘要/Abstract

摘要： 背景　随着基层医疗卫生机构改革的深化，社区未分化疾病逐渐被重视，且被认为对于基层医疗卫生机构整体服务能力的重要性不亚于慢性病管理，但目前国内关于全科医生对于未分化疾病诊疗情况的调查性或评价性研究相对少见。目的　了解上海市社区全科医生对社区常见未分化疾病认知度和诊疗能力自我评价现况，并尝试分析其可能的影响因素，为优化社区常见未分化疾病诊疗提供参考。方法　2019年6月至2020年6月，采用分层抽样的方法，抽取上海市城区和郊区的32家社区卫生服务中心的320例全科医生为研究对象。运用自制问卷了解全科医生对未分化疾病的认知度及诊疗能力自我评价情况。未分化疾病认知度及诊疗能力水平由被调查者依据Likert 5级量表评分自评。采用线性逐步回归分析全科医生未分化疾病诊疗能力水平影响因素。结果　回收有效问卷283份，有效回收率为88.4%。158例（55.8%）全科医生对未分化疾病定义和概念完全不了解或仅听说过但不太了解。完成住院医师规范化培训的全科医生对未分化疾病概念及定义、未分化疾病国内外研究进展、未分化疾病相关书籍及指南认知度更高（P<0.05）。被调查全科医生自评的未分化疾病常规诊疗能力平均得分为（3.32±0.567）分、未分化疾病急危重症急救处理能力平均得分为（3.42±0.677）分、未分化疾病转诊能力平均得分为（3.38±0.654）分。线性逐步回归分析结果显示，是否完成住院医师规范化培训、学历、职称、工作所在区域是全科医生未分化疾病常规诊疗能力的影响因素（P<0.05）；是否完成住院医师规范化培训是全科医生未分化疾病急危重症患者急救处理能力的影响因素（P<0.05）；是否完成住院医师规范化培训、工作所在区域是全科医生未分化疾病患者转诊能力的影响因素（P<0.05）。结论　全科医生对未分化疾病的认知度及诊疗能力有待进一步提高，住院医师规范化培训对于提高全科医生在未分化疾病各方面诊疗能力的影响较大。因此各方应给予社区未分化疾病更多的重视，并通过进一步落实和完善全科医师规范化培训及在未分化疾病诊疗中为全科医生提供更有效的临床循证依据和辅助支持，使其在未分化疾病诊疗中进一步发挥出全科诊疗的优势。

关键词: 未分化疾病, 全科医生, 认知度, 临床工作能力, 影响因素分析

Abstract: Background　Increasing attentions have been given to medically unexplained physical symptoms（MUPS） with the deepening of primary healthcare reform，and the capability of primary care in managing MUPS is considered as equal to managing chronic diseases. However，there are few investigative or evaluative studies on the diagnosis and treatment of MUPS by general practitioners（GPs） in China. Objective　To investigate the self-rated capability of identifying，diagnosing and treating MUPS of Shanghai GPs in primary care，and to attempt to explore the potential associated factors，providing a reference for raising GPs' capability of diagnosing and treating MUPS commonly encountered in the community. Methods　This study was carried out from June 2019 to June 2020. By use of stratified random sampling，320 GPs from 32 community health centers in Shanghai's urban and suburban areas were selected（10 were extracted from each community health center）. A 5-point Likert Scale Questionnaire developed by our research group was used in a survey to collect these GPs self-rated capability of identifying，diagnosing and treating MUPS. Stepwise linear regression was used to explore the factors potentially associated with GPs' capability of diagnosing and treating MUPS. Results　A total of 283 cases（88.4%） who completed the survey were included for final analysis. One hundred and fifty-eight（55.8%） GPs knew nothing about the definition and concept of MUPS or knew of MUPS without good understanding of MUPS. GPs who had standardized residency training program had a better understanding of the definition and concept，research status，books for continuing education，and guidelines regarding MUPS（P<0.05）. The average scores of self-rated capability of routinely diagnosing and treating MUPS，self-rated capability of emergently treating acute and severe MUPS，and self-rated capability of transferring MUPS patients by GPs，were （3.32±0.567），（3.42±0.677），
（3.38±0.654），respectively. Stepwise linear regression revealed that whether completing the standardized residency training program，education level，professional title，and the region of work were associated with GPs' self-rated capability of routinely diagnosing and treating MUPS（P<0.05）. The completion of the standardized residency training program was associated with GPs' self-rated capability of emergently treating acute and severe MUPS（P<0.05）. The completion of the standardized residency training program and region of work were associated with GPs' self-rated capability of transferring MUPS patients（P<0.05）. Conclusion　It is necessary to further improve Shanghai GPs' capability in the identification，diagnosis and treatment of MUPS. The standardized residency training may significantly improve GPs' capability in MUPS diagnosis and treatment. To improve the favorable influence of general practice in the diagnosis and treatment of MUPS，it is suggested to give more attention to MUPS，make more efforts to further improve the implementation of the standardized residency training for GPs，and provide effective evidence-based and adjuvant supports for diagnosing and treating MUPS.

Key words: Medically unexplained physical symptoms, General practitioners, Awareness, Clinical competence, Root cause analysis

周英达,卓书雄,金花,等. 上海市社区全科医生对未分化疾病认知度和诊疗能力的自我评价研究[J]. 中国全科医学, 2021, 24(31): 3979-3985. DOI: 10.12114/j.issn.1007-9572.2021.00.304.
ZHOU Yingda,ZHUO Shuxiong,JIN Hua, et al. Self-rated Capability of Identifying，Diagnosing and Treating Medically Unexplained Physical Symptoms in Shanghai General Practitioners in Community Health Centers　[J]. Chinese General Practice, 2021, 24(31): 3979-3985. DOI: 10.12114/j.issn.1007-9572.2021.00.304.

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