Page 111 - 中国全科医学2022-11

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District from April to July，2021. Eighteen rural physicians were selected to attend the interview as stakeholders. The interview
was guided by an outline developed based on a literature review and an expert consultation，including three parts：（1）
demographic characteristics（practice location，sex，age），（2）practicing qualifications（education level，starting time
of practicing，professional qualifications），（3）involvement in COVID-19 pandemic prevention and control（awareness of
the 10 instructions for COVID-19 pandemic containment in village clinics，participation in COVID-19 pandemic containment，
and personal protective equipment materials for COVID-19）. The interview was continued until data saturation. Results
Among the 18 rural physicians，14（77.8%） were certified as rural physicians，3（16.7%） were certified as rural assistant
general practitioners，2（11.1%） had a certificate of licensed physician and 1（5.6%） had a certificate of licensed assistant
physician. Except for one（5.6%），the rural physicians〔17（94.4%）〕 indicated that they knew the 10 instructions for
COVID-19 pandemic containment in the village clinic. The top three services about COVID-19 pandemic containment most
frequently provided by the rural physicians were health education （94.4%），information reporting（72.2%） and diagnosis
and treatment（64.7%），and the least provided was throat swab sampling〔only one case （5.6%）〕. In addition，three rural
physicians participated in providing other services，which included screening suspected COVID-19 cases in the village，guiding
COVID-19 pandemic containment in the village，and purchasing food for villagers. Ten physicians（55.6%）indicated that
personal protective equipment materials for COVID-19 were adequate，but other 8（44.4%） expressed that such materials were
inadequate during the first response phase. During the regular COVID-19 pandemic containment phase，16 physicians（88.9%）
indicated that personal protective equipment materials for COVID-19 were adequate，but other 2（11.1%） still indicated that
such materials were inadequate. The top four personal protective equipment materials for COVID-19 owned by the physicians in
regular COVID-19 pandemic containment phase were 84 Disinfectant（72.2%），ordinary disposable medical masks（66.7%），
disposable gloves（66.7%） and medical surgical masks（61.1%），and the least owned were medical protective clothing
（38.9%） and goggles（11.1%）. Conclusion Rural physicians play a necessary role in COVID-19 pandemic containment
in rural areas，but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19
pandemic containment services（including pharyngeal swab sampling），lack of a legal right to provide home-based isolation
and monitoring services，and inadequate personal protective equipment materials. Therefore，it is recommended that relevant
laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in
COVID-19 pandemic containment，recruit them to the public health team of the village committee，and ensure the provision of
emergency materials for village physicians to help them to realize their potential in pandemic containment.
【Key words】 COVID-19；Rural doctors；Epidemic prevention and control；Responsibilities；Grassroots governance

新型冠状病毒肺炎疫情暴发的突发性、严重性以及大规 狭义的乡村医生则是指尚未取得执业医师资格或者执业助理
模的流动人口跨区域迁移返乡致使农村成为疫情防控的重要 医师资格，经注册在乡村医疗卫生机构从事预防、保健和一
战场。2021 年年初，河北、黑龙江等多地农村暴发的疫情也 般医疗服务的人员 ［2］ 。本研究对象是广义的乡村医生。
再次警示，要把农村地区疫情防控作为重中之重。2020-02-14 1.2 方法 在广泛查阅文献资料和咨询专家意见的基础上，
召开的中央全面深化改革委员会第十二次会议指出，农村基 编制访谈提纲，内容包括：（1）乡村医生基本个人情况（包
层防控是疫情防控的第一道防线，要健全公共卫生服务体系， 括执业地点、性别、年龄），（2）乡村医生从业资质（包括
优化医疗卫生资源投入结构，加强农村等基层防控能力建 学历、执业起始时间和执业资质），（3）疫情防控工作参与
设 ［1］ 。本文调查了北京市怀柔区乡村医生在农村疫情防控中 情况（包括“村卫生室疫情防控十须知”知晓情况、疫情防
承担的职责，探讨其中存在的问题，并提出相应的建议。 控参与情况以及疫情防控物资拥有情况）。采用多（2~3 名访
1 对象与方法 谈员）对一（1 例乡村医生）、半结构化的个人深入访谈，访
1.1 研究对象 于 2021 年 4—7 月以北京市怀柔区为现场组 谈员均事先经过统一规范化培训，避免诱导性提问，减少研
织开展调研活动，根据地理位置、卫生服务可及性、村卫生 究偏倚。
室和乡村医生配置状况、疫情发生情况与疫情发生风险程度， 2 结果
在怀柔区选择长哨营满族乡、渤海镇、庙城镇 3 个乡镇，每 2.1 乡村医生年龄分布情况 18 例乡村医生中男 9 例，女 9
个乡镇分别选取 2 个大型村（常住人口 601~1 000 人）、2 个 例；年龄 39~76 岁，中位年龄为 65 岁。超过法定退休年龄的
中型村（常住人口 201~600 人）和 1 个小型村（常住人口不 乡村医生 13 例（72.2%），其中年龄在 55 岁及以上的女性乡
超过 200 人），共 15 个行政村为样本村，对村落进行非参与 村医生 5 例，年龄在 60 岁以上的男性乡村医生 8 例；按照 60
式观察和利益相关者的半结构化访谈，以信息饱和为原则， 岁及以上年龄分层，有 11 例（61.1%）乡村医生≥ 60 岁；按
访谈对象为样本村的 18 例乡村医生。广义的乡村医生是指在 照怀柔区“原则上年龄满 70 周岁必须退出乡村医生岗位”的
乡村医疗卫生机构从事医疗、预防、保健工作的所有医务人员， 要求，有 6 例（33.3%）乡村医生超过 70 岁，详见表 1。