Page 74 - 2022-22-中国全科医学

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·2759·

with pediatric patients in suburban districts are worthy of attention. Objective To understand the status and associated factors of
clinical encounters of GPs with pediatric patients in a suburban district of Beijing，providing a reference for the development of
tiered diagnosis and treatment of pediatric diseases. Methods In June 2021，purposive sampling was used to recruit GPs who
participated in a training named "Beijing Miyun District Medical Consortium Construction & General Practitioners' Comprehensive
Capability Improvement Project" to attend a semi-structured group interview for understanding the status of clinical encounters
of GPs with pediatric patients and related influencing factors. The interview results were recorded，and transcribed，then coded
using NVivo 12，and analyzed using thematic analysis. Results Nineteen GPs（5 men and 14 women）in the age range of 24-
51 years〔average age of（33.2±7.6）years〕，attended the interview，18 of whom had a bachelor degree；9 had a title of
attending physician；1 had participated in the standardized general practice residency program；8 had participated in the "3+2"
assistant general practitioners training program；8 had participated in the standardized training before making a career change
into general practice. The average years of them working a GP was 1-18 years〔（6.3±4.8）years on average〕. Four themes
emerged from the analysis：（1）Both the numbers of pediatric patients and illnesses encountered by suburban GPs were less
than those encountered by their urban counterparts，and pediatric patients encountered by suburban GPs aged greater than or
equal to 3 years.（2）Suburban GPs generally had a low level of self-confidence in treating pediatric patients.（3）The major
factors negatively affected suburban GPs encountering pediatric patients include the pediatric patient's parents with a lower level
of trust in their GP，inadequate capabilities of GPs in managing pediatric patients，high risk of managing pediatric patients，
underperformance of nurses，inadequate available pediatric medicines and equipments for laboratory tests in the community，
and lack of a clear referral system.（4）The major facilitators for suburban GPs to encounter pediatric patients include managing
pediatric patients in the community by pediatricians，and increasing pediatric medicines and equipments for laboratory tests.
Conclusion The encounters of suburban GPs with pediatric patients in primary care were unsatisfactory due to many problems
and challenges. To improve the situation，it is suggested to improve the capabilities of suburban GPs in managing pediatric
patients by trainings，the collaboration between GPs and pediatricians， and the tiered system for the diagnosis and treatment of
pediatric diseases.
【Key words】 General practitioners；Child health services；Community health services；Qualitative research

近年来，儿童“就医难”问题日益凸显。新近发布 有 1 名全科医生提供规范的儿童基本医疗服务，基本
的《柳叶刀中国女性生殖、孕产妇、新生儿、儿童和青 满足儿童医疗卫生需求 ［6］ 。北京市密云区地处京郊，
少年健康特邀重大报告》呼吁：提高初级卫生保健中妇 距北京城区 70 km，2021 年全区居民人均可支配收入
幼卫生服务的能力，提升妇幼健康服务的质量，切实改 39 282 元，每千常住人口医疗卫生机构床位数 3.65
善妇幼健康服务的公平性与可及性 ［1］ 。社区卫生服务 张 ［7］ ，相较于北京市 2021 年全市居民人均可支配收入
机构能够接诊儿童是改善儿童“就医难”问题、推进儿 75 002 元、每千常住人口医疗卫生机构床位数 5.94 张
童疾病分级诊疗的有效举措 ［2］ 。既往研究结果显示， 而言，医疗资源相对匮乏、经济发展水平相对较低，但
儿童健康服务人员数量不足、理论知识水平不高，儿童 其 0~14 岁人口占区常住总人口的比例为 12.7%，儿童
医疗服务资源紧张是制约城市社区卫生服务中心儿童健 医疗服务需求旺盛 ［8］ 。本研究以北京市密云区为样本
康服务工作顺利开展的主要因素 ［3］ 。一项针对北京市 来源地，对来自该区 19 家社区卫生服务中心的全科医
社区卫生服务中心接诊儿童现况的调查研究结果显示， 生骨干进行访谈，探寻在医疗资源相对匮乏和经济发展
北京市社区卫生服务中心接诊儿童的功能严重萎缩，接 水平相对较低的郊区，全科医生接诊儿童的现况及其影
诊儿童的全科医生逐步减少 ［4］ 。2015 年开展的一项电 响因素，从基层全科医生视角深入了解郊区全科医生在
话调查发现，以北京市为例，在参与调查的 210 家社区 接诊儿童方面存在的问题及面临的困难，为后续儿童疾
卫生服务中心中，41.4% 的社区卫生服务中心不接诊儿 病分级诊疗的开展提供依据。
童，但地处密云和延庆两大郊区的社区卫生服务中心均 1 对象与方法
接诊儿童 ［5］ 。郊区综合医院数量少、经济发展相对薄 为了增强受访者间的相互作用，积极引发受访者间
弱、儿童就医交通不便等因素，可能是导致郊区社区卫 的观点碰撞，激发新的思考和想法，在短时间内有效获
生服务中心接诊儿童情况优于城区的原因 ［5］ 。随着《关 取大量信息，本研究采用焦点小组访谈法。
于印发加强儿童医疗卫生服务改革与发展意见的通知》 1.1 研究对象 于 2021 年 6 月，采用目的抽样法，选
（国卫医发〔2016〕21 号）的出台，北京市提出要求， 取参加“北京市密云区医共体建设暨全科医师综合服务
到 2020 年，每个乡镇卫生院和社区卫生服务机构至少 能力提升项目骨干培训”的全科医生骨干作为研究对象。