摘要
背景“康复回社区”是形成合理就医格局的重点要求,也是实现人人享有康复服务的重要策略,但目前我国基层医生的社区康复服务能力与居民日益增长的康复需求仍有差距。目的了解我国基层医生社区康复服务能力的现状、特点与不足,为制定能力提升对策提供科学依据。方法2020年8月采用多阶段分层抽样与典型抽样相结合的方法对中国江苏省、安徽省、河南省、重庆市、甘肃省五地基层医疗卫生机构的医生开展问卷调查,从康复功能评定、康复医疗服务、中医药保健指导、中医理疗四个方面调查基层医生社区康复服务能力现状。结果共回收8374份问卷,接受调查的基层医生中,分别有4697名(56.1%)、6396名(76.4%)、5833名(69.7%)、4834名(57.7%)具备康复功能评定、康复医疗服务、中医药保健指导、中医理疗能力,且农村地区基层医生各项社区康复能力及综合能力具备率均高于城市地区(P<0.05)。不同年龄、学历、执业资格、岗位基层医生的康复医疗服务指导、中医药保健指导、中医理疗能力具备率比较,差异有统计学意义(P<0.05);组内两两比较结果显示,在年龄方面,30岁以下及60岁以上基层医生康复功能评定能力的具备率高于30~<45岁、45~<60岁(P<0.016),45~<60岁医生具备率高于30~<45岁(P<0.016),45岁以下的康复医疗服务指导能力具备率低于45岁以上的基层医生(P<0.016);30岁以下基层医生中医药保健指导、中医理疗能力具备率低于30~<45岁、45~<60岁和60岁以上(P<0.016),30~<45岁医生能力具备率低于45~<60岁和60岁以上(P<0.016),45~<60岁医生具备率低于60岁以上(P<0.016)。在学历方面,高中/中专及以下学历基层医生能力具备率高于大专学历和本科学历(P<0.016),大专学历医生能力具备率高于本科学历(P<0.016)。在执业资格方面,全科医师具备率高于乡村医师和执业(助理)医师(P<0.016),乡村医师具备率高于执业(助理)医师(P<0.016)。在工作岗位方面,中医岗位基层医生中医药保健指导、中医理疗能力具备率高于临床岗位和其他岗位(P<0.016),临床岗位具备率高于其他岗位(P<0.016)。基层医生康复医疗综合能力具备率高于中医康复综合能力(P<0.05)。结论基层医生社区康复服务能力总体不足,中医康复能力较为薄弱。应完善分级康复服务体系建设,促进基层医生康复经验的积累和能力的提升,加强基层医生中医康复与西医现代康复技术联合培养,完善基层康复人才队伍建设,使其能承担起社区康复的责任。
Background With the promotion of"strengthening the primary health"measures,the number of primary health professionals in China has increased significantly,but there is still a gap between the ability of primary care physicians and basic medical needs of residents.Objective To understand the current situation,characteristics and deficiencies of Chinese primary care doctors'community rehabilitation service ability,so as to provide scientific basis for making countermeasures to improve ability.Methods The method of multi-stage stratified sampling combined with typical sampling was adopted to carry out an online questionnaire survey on doctors in primary health institutions in Jiangsu province,Anhui province,Henan province,Chongqing City and Gansu province.The current situation of community rehabilitation service ability of primary care physicians was evaluated from four aspects:rehabilitation function evaluation,rehabilitation medical service,traditional Chinese medicine health guidance and traditional Chinese medicine physiotherapy.Results A total of 8374 questionnaires were analyzed.Among the primary doctors surveyed,4697 cases(56.1%),6396 cases(76.4%),5833 cases(69.7%)and 4834 cases(57.7%)were equipped with the ability of rehabilitation function assessment,rehabilitation medical services,TCM health guidance and TCM physiotherapy,respectively.Moreover,the abilities of primary doctors in rural areas were better than that in urban areas,and the difference was statistically significant(P<0.05).There were statistically significant differences in the rates of rehabilitation medical service guidance,traditional Chinese medicine health care guidance and traditional Chinese physiotherapy ability of primary doctors in different ages,educational qualifications,and positions(P<0.05).The pairwise comparison results showed that in terms of age.In terms of assessment ability of rehabilitation function,doctors under 30 years old and over 60 years old had a higher rate than those 30-<45 years old and 45-<60 years old(P<0.016),and doctors 45-<60 years old had a higher rate than those 30-<45 years old(P<0.016).The rate of rehabilitation medical service guidance ability of primary doctors under 45 years old was lower than that of primary doctors over 45 years old(P<0.016).The ability rate of doctors under 30 years old to provide TCM health care guidance and TCM physiotherapy was lower than that of 30-<45 years old,45-<60 years old and over 60 years old(P<0.016),and the ability rate of doctors 30-<45 years old was lower than that of 45-<60 years old and over 60 years old(P<0.016).The ratio of doctors aged 45-<60 years old was lower than that of doctors aged over 60 years old(P<0.016).The ability rate of primary doctors with high school/secondary school education or below was higher than that of college degree and bachelor degree(P<0.016),and the ability rate of junior college degree doctors was higher than that of bachelor degree(P<0.016).The possessing rate of general practitioners was higher than that of rural physicians and practicing(assistant)physicians(P<0.016),and the possessing rate of rural physicians was higher than that of practicing(assistant)physicians(P<0.016).The rate of basic doctors in TCM post possessing TCM health care guidance and TCM physiotherapy ability was higher than that in clinical post and other post(P<0.016),and the rate of clinical post possessing was higher than that in other post(P<0.016).The rate of comprehensive ability of rehabilitation medicine was higher than that of traditional Chinese medicine(P<0.05).Conclusion The ability of community rehabilitation was insufficient on the whole,and the ability of traditional Chinese medicine rehabilitation was relatively weak.It is necessary to improve the construction of the tiered diagnosis and treatment system,promote primary care physicians'experience and abilities.Also to strengthen the joint training of traditional Chinese medicine rehabilitation and modern Western medicine rehabilitation techniques,complete the training and construction of primary rehabilitation personnel,so that they can assume the responsibility of community rehabilitation.
作者
练璐
王敌
陈家应
刘武
LIAN Lu;WANG Di;CHEN Jiaying;LIU Wu;无(Department of Operations Management,Jiangsu Province Hospital/the First Affiliated Hospital with Nanjing Medical University/Jiangsu Women and Children Health Hospital,Nanjing 210029,China;Department of Organization and Human Resources,Jiangsu Province Hospital/the First Affiliated Hospital with Nanjing MedicalUniversity/Jiangsu Women and Children Health Hospital,Nanjing 210029,China;School of Humanities and Management,Kangda College of Nanjing Medical University,Lianyungang 222000,China;Department of Discipline Inspection,Jiangsu Province Hospital/the First Affiliated Hospital with Nanjing Medical University/Jiangsu Women and Children Health Hospital,Nanjing 210029,China)
出处
《中国全科医学》
CAS
北大核心
2025年第4期450-456,共7页
Chinese General Practice
基金
国家自然科学基金面上项目(71874087)。
关键词
初级卫生保健
基层医生
社区康复
分层分析
城乡地区
Primary health care
Primary care physician
Community-based rehabilitation
Hierarchical analysis
Urban and rural areas
