农村订单定向医学毕业生参与新型冠状病毒肺炎疫情防控情况研究

doi:10.12114/j.issn.1007-9572.2021.00.298

摘要/Abstract

摘要： 背景　新型冠状病毒肺炎（简称新冠肺炎）疫情防控期间，基层卫生工作者起到了十分重要的作用。我国于2010年发文启动实施农村订单定向医学生免费培养工作，从2015年起至今已有数届订单定向医学生完成了本科学业，其在疫情防控中的工作情况值得关注。目的　调查订单定向毕业生和其他临床五年制毕业生参与新冠肺炎疫情防控工作情况，分析订单定向毕业生在疫情防控中发挥的作用及存在的困难与挑战，并提出针对性政策建议。方法　本研究数据来源于“订单定向医学生队列研究”项目，本次随访调查于2020年9月采用电子问卷形式开展，有效随访我国中西部4所医学院校2015—2019届共1 631例订单定向毕业生和1 009例其他临床五年制毕业生，调查内容包括基本信息、基本工作情况、疫情期间工作情况等。结果　在调查期间处于工作状态的毕业生中，订单定向毕业生的疫情防控工作参与率高于其他临床五年制毕业生〔70.18%（1 113/1 586）比51.58%（293/568），P<0.05〕。订单定向毕业生中，男性参与率高于女性（P<0.05），2015—2016届参与率高于2017—2019届（P<0.05），已婚者参与率高于未婚/离异/其他婚姻状况者（P<0.05）。在参与疫情防控工作的订单定向毕业生中，参与较多的服务类别为健康宣传与教育〔88.59%（986/1 113）〕、社区防疫与管理〔85.62%（953/1 113）〕、核酸检测与筛查〔67.30%（749/1 113）〕，面临的常见挑战为缺少防护设备〔77.72%（865/1 113）〕、工作量和/或工作压力太大〔41.87%（466/1 113）〕、担心自己或家人被感染〔37.56%（418/1 113）〕，认为疫情防控期间的日常临床工作量、日常公共卫生工作量增多的人员占比分别为57.50%（640/1 113）和62.26%（693/1 113）。结论　订单定向毕业生在疫情防控过程中承担了多项重要工作，对全国的疫情防控发挥了不可忽视的作用，但是同时存在着防护设备不足、工作压力过大等问题。建议进一步改善基层卫生设施，为基层医务工作者提供更多的防护与支持。

关键词: 全科医生；农村订单定向医学生；新型冠状病毒肺炎；疫情防控；教育, 医学；初级卫生保健

Abstract: Background　Primary healthcare workers have played an important role in combating the COVID-19 pandemic. Beginning in 2010，China initiated a national policy of implementing the rural-oriented tuition-free medical education（RTME） program，aiming to train general practitioners（GPs） with a medical undergraduate degree to work in rural areas to address the shortage of rural physicians. Since 2015，many graduates with RTME returned to the contracted rural hospital to fulfill a 3-year obliged health services，and their performance in combating COVID-19 epidemic is worth to be concerned about. Objective　To compare the participation and role of target admission GPs and other graduates trained with a five-year undergraduate degree program for clinical medical students in combating COVID-19 pandemic，and to analyze the duties and challenges for target admission GPs during the anti-pandemic period，then based on this，to put forward policy recommendations for incentivizing target admission GPs. Methods　The data were sourced from the Target Admission Medical Students Cohort Study Program. We conducted a follow-up survey among 1 631 target admission GPs and 1 009 other clinical medical graduates graduating from 4 medical colleges in central and western China using an online questionnaire in September 2020. Basic demographics，job information and work status during the COVID-19 pandemic were collected. Results　Among those who were employed in the study period，target admission GPs had a higher rate of participating in combating COVID-19 pandemic than other clinical medical graduates〔70.18%（1 113/1 586）vs 51.58%（293/568），P<0.05〕. Among target admission GPs，men had a higher rate of being involved in combating COVID-19 pandemic than women（P<0.05）；those admitted in 2015 and 2016 had a higher rate of being involved in combating COVID-19 pandemic than those admitted during 2017 to 2019（P<0.05）；and those who were married had a higher rate of being involved in combating COVID-19 pandemic than those who were unmarried/divorced/other marital status（P<0.05）. The top 3 types of work which most target admission GPs participated were "health promotion and education"〔88.59%（986/1 113）〕，"community epidemic prevention and management"〔85.62%（953/1 113）〕，and "SARS-CoV-2 nucleic acid testing and screening"〔67.30%（749/1 113）〕. The top three challenges most target admission GPs faced in combating COVID-19 pandemic were "lack of personal protective equipment"〔77.72%（865/1 113）〕，"too much workload and/or pressure"〔41.87%（466/1 113）〕，and "worrying about themselves and their family being infected"〔37.56%（418/1 113）〕. The prevalence of target admission GPs who reported that there was an increase in daily clinical work was 57.50%（640/1 113）. And that of target admission GPs who reported that there was an increase in daily public health services was 62.26%（693/1 113）. Conclusion　Target admission GPs have implemented multiple key services regarding COVID-19 containment，indicating that they have played a role in the national COVID-19 containment that cannot be ignored. However，they faced difficulties such as insufficient personal protective equipment and excessive work pressure. Measures need to be taken to improve the infrastructures in rural areas，and to provide more protection and support for primary healthcare workers.

Key words: General practitioners；Target admission medical graduates；COVID-19；Epidemic prevention and control；Education, medicine；Primary health care

程昊哲,王子岳,张柏松,等. 农村订单定向医学毕业生参与新型冠状病毒肺炎疫情防控情况研究[J]. 中国全科医学, 2021, 24(31): 4003-4008. DOI: 10.12114/j.issn.1007-9572.2021.00.298.
CHENG Haozhe,WANG Ziyue,ZHANG Baisong, et al. Cross-sectional Study of Target Admission General Practitioners' Participation in Combating COVID-19 Pandemic　[J]. Chinese General Practice, 2021, 24(31): 4003-4008. DOI: 10.12114/j.issn.1007-9572.2021.00.298.

参考文献

［1］梁万年，王辰，吴沛新. 中国医改发展报告（2020）［M］. 北京：社会科学文献出版社，2020.
［2］李强. 影响农村订单定向医学生服务基层因素研究及对策分析［J］. 中国卫生事业管理，2013，30（12）：937-939.
LI Q. Research and countermeasure on influencing factors of the grass roots service of rural-oriented medical students［J］. Chinese Health Service Management，2013，30（12）：937-939.
［3］国家发展改革委，原卫生部，教育部，等. 关于印发开展农村订单定向医学生免费培养工作实施意见的通知［Z］. 2010.
［4］国家卫生健康委办公厅. 关于加强基层医疗卫生机构新型冠状病毒感染的肺炎疫情防控工作的通知［Z］. 2020.
［5］张冬莹，姚弥，王家骥，等. 农村地区基层医疗卫生机构新型冠状病毒感染防控工作指（第一版）［J］. 中国全科医学，2020，23（7）：763-769. DOI：10.12114/j.issn.1007-9572.2020.00.246.
ZHANG D Y，YAO M，WANG J J，et al. Guidance on the control and prevention of SARS-CoV-2 infection in primary healthcare settings in rural China（first edition）［J］. Chinese General Practice，2020，23（7）：763-769. DOI：10.12114/j.issn.1007-9572.2020.00.246.
［6］蔡瑜，弥曼，李亚军，等. 农村订单定向免费本科医学教育人才培养模式的实践与探讨［J］. 中华全科医学，2018，16（10）：1734-1736，1772. DOI：10.16766/j.cnki.issn.1674-4152.000472.
CAI Y，MI M，LI Y J，et al. Practice and discussion on training mode of rural order-directed tuition-free general medical practitioner［J］. Chinese Journal of General Practice，2018，16（10）：1734-1736，1772. DOI：10.16766/j.cnki.issn.1674-4152.000472.
［7］杨永丽，盛文楷，杜进林. 农村订单定向医学生身份认同现状及影响因素分析［J］. 中国农村卫生事业管理，2021，41（7）：481-486. DOI：10.19955/j.cnki.1005-5916.2021.07.005.
YANG Y L，SHENG W K，DU J L. Identity recognition of rural order-oriented medical students：status quo and the influencing factors［J］. Chinese Rural Health Service Administration，2021，41（7）：481-486. DOI：10.19955/j.cnki.1005-5916.2021.07.005.
［8］王子岳，胡丹，张柏松，等. 订单定向医学生的工作意愿：基于四所医学院校的三年跟踪分析［J］. 中国卫生政策研究，2020，13（11）：57-62. DOI：10.3969/j.issn.1674-2982.2020.11.009.
WANG Z Y，HU D，ZHANG B S，et al. Analysis on the targeted admission medical graduates and their work preference in rural areas：a three-year survey conducted in four medical schools［J］.Chinese Journal of Health Policy，2020，13（11）：57-62. DOI：10.3969/j.issn.1674-2982.2020.11.009.
［9］张超，陈楚康，张众，等. 首届订单定向医学毕业生就业现状研究［J］.中国卫生政策研究，2017，10（5）：27-33. DOI：10.3969/j.issn.1674-2982.2017.05.005.
ZHANG C，CHEN C K，ZHANG Z，et al. Study on the current employment situation of targeted admission medical graduates in rural areas［J］. Chinese Journal of Health Policy，2017，10（5）：27-33. DOI：10.3969/j.issn.1674-2982.2017.05.005.
［10］张众，张超，黄明玉，等. 农村订单定向医学生就业与规培：两年跟踪分析［J］.中国卫生政策研究，2018，11（9）：34-39. DOI：10.3969/j.issn.1674-2982.2018.09.006.
ZHANG Z，ZHANG C，HUANG M Y，et al. Two-year follow-up analysis of targeted admission medical graduates in rural areas［J］. Chinese Journal of Health Policy，2018，11（9）：34-39. DOI：10.3969/j.issn.1674-2982.2018.09.006.
［11］胡丹，陈楚康，张超，等. 我国农村订单定向免费医学生培养成效及存在问题［J］. 中国卫生政策研究，2018，11（9）：28-33. DOI：10.3969/j.issn.1674-2982.2018.09.005.
HU D，CHEN C K，ZHANG C，et al. Effectiveness and challenges of targeted admission medical education program in rural China［J］. Chinese Journal of Health Policy，2018，11（9）：28-33. DOI：10.3969/j.issn.1674-2982.2018.09.005.
［12］杨晨斌，李艳梅，李章平，等. 新型冠状病毒肺炎疫情下基层医生自我角色定位与专家建议一致性及影响因素研究［J］. 中国全科医学，2021，24（1）：17-22，29. DOI：10.12114/j.issn.1007-9572.2021.00.027.
YANG C B，LI Y M，LI Z P，et al. Roles of primary care doctors in COVID-19 pandemic：level of consistency across perceptions of doctors and experts and impact factors［J］. Chinese General Practice，2021，24（1）：17-22，29. DOI：10.12114/j.issn.1007-9572.2021.00.027.
［13］LIU Q，LUO D，HAASE J E，et al. The experiences of health-care providers during the COVID-19 crisis in China：a qualitative study［J］. Lancet Glob Health，2020，8（6）：e790-798.DOI：10.1016/S2214-109Xygv(20)30204-7.
［14］LI X，KRUMHOLZ H M，YIP W，et al. Quality of primary health care in China：challenges and recommendations［J］. Lancet，2020，395（10239）：1802-1812. DOI：10.1016/S0140-6736(20)30122-7.
［15］俞文雅，石建伟，王慧. 重大传染病疫情下对基层医疗卫生机构职能的思考［J］. 上海预防医学，2020，32（7）：561-565.DOI：10.19428/j.cnki.sjpm.2020.20125.
YU W Y，SHI J W，WANG H. Function of primary health care institutions in pandemics［J］. Shanghai Journal of Preventive Medicine，2020，32（7）：561-565. DOI：10.19428/j.cnki.sjpm.2020.20125.
［16］代华，方荣华，雷弋，等. 新型冠状病毒肺炎疫情下基层一线医务人员暴露风险及防护建议［J］. 四川医学，2020，41（3）：257-261. DOI：10.16252/j.cnki.issn1004-0501-2020.03.007.
DAI H，FANG R H，LEI Y，et al. Recommendation on exposure risks and protections of primary care professionals in Coronavirus Disease 2019 outbreak［J］. Sichuan Medical Journal，2020，41（3）：257-261. DOI：10.16252/j.cnki.issn1004-0501-2020.03.007.
［17］NGUYEN L H，DREW D A，GRAHAM M S，et al. Risk of COVID-19 among front-line health-care workers and the general community：a prospective cohort study［J］. Lancet Public Health，2020，5（9）：e475-483. DOI：10.1016/S2468-2667(20)30164-X.
［18］RAWAF S，ALLEN L N，STIGLER F L，et al. Lessons on the COVID-19 pandemic，for and by primary care professionals worldwide［J］. Eur J Gen Pract，2020，26（1）：129-133.DOI：10.1080/13814788.2020.1820479.
［19］叶响裙. 全面加强基层医疗卫生服务体系建设［J］. 中国国情国力，2020，334（11）：14-17. DOI：10.13561/j.cnki.zggqgl.2020.11.004.
［20］XU Z，YE Y，WANG Y，et al. Primary care practitioners' barriers to and experience of COVID-19 epidemic control in China：a qualitative study［J］. J Gen Intern Med，2020，35（11）：3278-3284. DOI：10.1007/s11606-020-06107-3.
［21］CHERSICH M F，GRAY G，FAIRLIE L，et al. COVID-19 in Africa：care and protection for frontline healthcare workers［J］. Global Health，2020，16（1）：46. DOI：10.1186/s12992-020-00574-3.