CAJ | 학술논문

目的探讨“专家网络跟踪临床指导”的培训模式对提高社区医生高血压防治知识以及临床诊治水平的作用.方法 2008年12月选择浙江省杭州市、嘉兴市、绍兴市20家社区卫生服务中心的855名社区医生,进行高血压临床知识和病例诊治能力的基线问卷调查.以其中网络信息系统健全的10家社区卫生服务中心430名为干预组,采用知识培训结合网络指导的模式进行3年的全程跟踪指导；另10家社区卫生服务中心中425名为对照组,仍用常规集中授课培训模式.干预后于2011年12月再次进行问卷调查,并对两种模式的培训效果进行评价.结果干预组社区医生运用专家网络跟踪指导模式培训后高血压的知识和病例诊治能力均明显提高；对高血压防治基础知识、高血压非药物治疗和药物治疗知识的正确回答率分别由37.0％ (159/430)、45.6％ (196/430)、42.8％(184/430)提高到66.8％(284/425)、81.4％(346/425)、77.6％(330/425)；高血压诊治正确率由干预前的38.4％(496/1290)提高到73.3％ (946/1290)(P＜0.01).对照组医生培训后高血压知识和病例诊治水平也有所提高,但升高的幅度明显低于干预区.结论 “专家网络跟踪指导”模式能更有效地提高社区医生高血压防治知识和临床诊治水平,有效地改善培训模式是提高社区医生高血压诊治水平的重要措施之一.
목적 탐토“전가망락근종림상지도”적배훈모식대제고사구의생고혈압방치지식이급림상진치수평적작용.방법 2008년12월선택절강성항주시、가흥시、소흥시20가사구위생복무중심적855명사구의생,진행고혈압림상지식화병례진치능력적기선문권조사.이기중망락신식계통건전적10가사구위생복무중심430명위간예조,채용지식배훈결합망락지도적모식진행3년적전정근종지도；령10가사구위생복무중심중425명위대조조,잉용상규집중수과배훈모식.간예후우2011년12월재차진행문권조사,병대량충모식적배훈효과진행평개.결과 간예조사구의생운용전가망락근종지도모식배훈후고혈압적지식화병례진치능력균명현제고；대고혈압방치기출지식、고혈압비약물치료화약물치료지식적정학회답솔분별유37.0％ (159/430)、45.6％ (196/430)、42.8％(184/430)제고도66.8％(284/425)、81.4％(346/425)、77.6％(330/425)；고혈압진치정학솔유간예전적38.4％(496/1290)제고도73.3％ (946/1290)(P＜0.01).대조조의생배훈후고혈압지식화병례진치수평야유소제고,단승고적폭도명현저우간예구.결론 “전가망락근종지도”모식능경유효지제고사구의생고혈압방치지식화림상진치수평,유효지개선배훈모식시제고사구의생고혈압진치수평적중요조시지일.
Objective To evaluate the application of “expert-guided network tracking system” in training community general practitioner for hypertension management.Methods Total 855 general practitioners (GPs) from 20 community health service centers in Hangzhou,Jiaxing and Shaoxing of Zhejiang province were divided into two groups: 430 GPs from 10 community health centers received training for hypertension management using “ expert-guided networking tracking system” (intervention group) in December 2008 and 425 GPs from another 10 health centers received conventional training (control group).Questionnaire surveys about the knowledge and skill of hypertension management were conducted before and 3 y after training.Results The awareness rates of knowledge about hypertension prevention and control,non-drug therapy and drug therapy increased from 37.0％ (159/430),45.6％ (196/430),42.8％ (184/430) to 66.8％ (284/425),81.4％ (346/425),77.6％ (330/425),respectively and the accuracy of case analysis increased from 38.4％ (490/1290) to 73.3％ (946/1290) (P ＜0.01) after training in intervention group.Meanwhile the knowledge and case management abilities in control group were also improved after conventional training,but the degree was significantly lower than that in the intervention group.Conclusions “Expert-guided networking tracking system” can significantly improve the knowledge and skills for hypertension management in community general practitioners.