摘要
背景从2011年4月起,家庭医生制度建设成为上海市医药卫生体制改革五大基础性工程之一,家庭医生是落实该制度的“主力军”,持续了解其执业信心水平对于推动我国家庭医生事业高质量发展至关重要。目的了解2020年上海市浦东新区家庭医生信心指数及其未来3年的执业信心水平,分析2014—2020年上海市浦东新区家庭医生信心指数变化情况,旨在为家庭医生制度建设的深入推进提供一定的参考。方法于2020年12月,以2014年参与上海市浦东新区家庭医生信心指数调查的9家社区卫生服务中心为样本来源地,选取在职并且正在从事家庭医生相关工作的全科医生作为研究对象,通过“问卷星”对其进行线上问卷调查。问卷由研究者根据目前上海市浦东新区的实际情况,结合原《中国医学论坛报·全科医学周刊》2017年6月22日第E2~E3版内容和顾湲家庭医生工作室明确的家庭医生信心指数调查内容自行设计。比较不同特征家庭医生2020年信心指数及其未来3年的执业信心水平差异,分析全体及不同特征家庭医生未来3年执业信心变化趋势,探讨2014—2020年家庭医生信心指数的变化情况。结果共发放问卷350份,回收有效问卷347份,有效问卷回收率为99.1%。2020年家庭医生平均信心指数为(51.96±28.42),2023年家庭医生平均信心指数预测值为(54.03±26.56),两者比较,差异无统计学意义(P>0.05)。与单位所在地为城镇/城郊结合地区、通过住院医师规范培训或职称考试成为全科医生、受教育程度为本科/硕士研究生及以上、未同时担任院内行政职务或从事院内行政工作者相比,单位所在地为郊区、通过转岗培训成为全科医生、受教育程度为大专及以下、同时担任院内行政职务或从事院内行政工作者2020年信心指数更高,差异有统计学意义(P<0.05);与单位所在地为城镇/城郊结合地区、受教育程度为本科/硕士研究生及以上者相比,单位所在地为郊区、受教育程度为大专及以下者2023年信心指数预测值更高,差异有统计学意义(P<0.05)。单位所在地为城镇地区、男性、年龄为23~29岁、从事家庭医生相关工作≤1年或>5年、受教育程度为本科、拥有中级职称、未同时担任院内行政职务或从事院内行政工作者2023年信心指数预测值高于2020年信心指数,差异有统计学意义(P<0.05)。2020年家庭医生信心指数高于2014年(24.65±22.75)及2017年(48.20±23.10),差异有统计学意义(P<0.05)。结论上海市浦东新区家庭医生2020年信心指数较2014、2017年明显升高,处于中立水平;2023年家庭医生信心指数预测值仍处于中立水平。不同特征家庭医生当下和未来3年的执业信心水平存在差异。家庭医生对行业及自身的发展充满信心,需要持续的政策和社会支持。
Background Family doctors play a major role in the construction of the family doctor system,one of the five basic projects in Shanghai launched since April 2011,so understanding their confidence level regarding practice is crucial to the promotion of high-quality development of family doctor system in China.Objective To investigate the family doctor confidence index(FDCI)in 2020 and its trend from 2014 to 2020 among general practitioners(GPs)in Pudong New Area of Shanghai,and to predict their future 3-year FDCI,providing insights into the promotion of the construction of family doctor system.Methods Participants were incumbent GPs who provided family care services in 9 community health centers in Pudong New Area of Shanghai,the settings in which the 2014 FDCI survey in Shanghai's Pudong New Area was conducted.They were invited to attend an online survey through the platform of www.wjx.cn in December 2020 using a questionnaire developed by ourselves based on the implementation of family doctor system in Pudong New Area,the contents of E2-E3 pages of the original China Medical Tribune·General Practice Weekly published on June 22,2017,and the survey contents of FDCI developed by GU Yuan Family Doctor Studio.FDCI was compared by demographic indices.The future 3-year FDCI was estimated overall,and compared across GPs by demographic indices.The trend of FDCI between 2014 and 2020 was analyzed.Results A total of 350 cases attended the survey,and 347 of them(99.1%)who returned were responsive questionnaires were included for analysis.The average FDCI of the participants was(51.96±28.42)in 2020,and that predicted for 2023 was(54.03±26.56),showing no significant difference(P>0.05).In 2020,GPs working at rural areas had higher FDCI than those working at urban and periurban areas(P<0.05);Those who became a GP after training prior to the post shift had higher FDCI than those who became a GP after standardized residency training or passing the professional title examination(P<0.05);GPs with junior college education or below had higher FDCI than those with a bachelor/master degree or above(P<0.05);GPs who held a concurrent administrative post or handled administrative matters in their hospital had higher FDCI than those did not(P<0.05).Higher FDCI predicted for 2023 was found in those with working at rural areas instead of those working at urban and peri-urban areas,and in those with junior college education or below instead of those with a bachelor/master degree or above(P<0.05).Those who were male,aged 23-29,worked at urban area,had an experience of≤1 or>5 years of working as a family doctor,had a bachelor degree or intermediate professional title were predicted to have higher FDCI in 2023 than in 202(0 P<0.05).The overall FDCI in 2020 was higher than that in 201〔4(51.96±28.42)vs(24.65±22.75)〕and 2017〔(51.96±28.42)vs(48.20±23.10)〕,with statistical significance(P<0.05).Conclusion The overall FDCI of GPs in Shanghai's Pudong New Area in 2020 and that predicted for 2023 was moderate,and the overall FDCI in 2020 was significantly higher than that in 2014 and 2017.The present and future 3-year FDCI varied among GPs by demographic characteristics.GPs were fully confident in the future development of the industry and their own occupation,and needed continuous policy and social supports.
作者
唐慧芸
方佳良
沙婧婧
吴晓飞
TANG Huiyun;FANG Jialiang;SHA Jingjing;WU Xiaofei(Department of General Practice,Pudong New Area Jinyang Community Health Center,Shanghai 200136,China;Department of Prevention and Health Care,Pudong New Area Jinyang Community Health Center,Shanghai 200136,China)
出处
《中国全科医学》
CAS
北大核心
2022年第34期4332-4338,共7页
Chinese General Practice
基金
上海市浦东新区卫生健康委员会社区卫生学科带头人培养项目(PWRsd2019-04)。
关键词
家庭医生
全科医生
信心指数
执业信心
社区卫生服务
上海
Family doctors
General practitioners
Confidence index
Licensed confidence
Community health services
Shanghai
