CAJ | 학술논문

目的了解浙江省社区医生对慢性非传染性疾病防治知识的获取途径、需求以及解决临床疑难问题的主要方式,分析影响社区医生将知识转化为临床诊治能力的因素.方法 2011年1月至2012年12月,对参加浙江省科技厅公益性技术应用研究计划项目《高血压社区控制技术对心血管病人群防治基地建设的影响研究》基层医生培训的891名社区医生,进行有关慢性病知识的获取途径以及处理临床疑难问题的方式、目前常规培训存在的问题和影响自身能力提高的因素等内容的问卷调查.结果回收有效问卷855份.855名社区医生中,35.2％(301/855)选择“常规培训课程”是获取慢性病防治知识的主要途径,其次是阅读专业期刊书籍(17.8％,152/855)和上级医生指导(17.2％,147/855)；不同级别医院、不同职称的社区医生获取知识途径不同,组间比较差异有统计学意义(P＜0.05).当社区医生在慢性病防治临床工作中遇到问题时,36.5％(23/63)的高级职称医生常用的解决问题方式为“查看教科书籍或期刊”,其次是“查看有关疾病的诊疗指南”者占31.7％(20/63)；27.1％ (68/251)的中级职称医生和29.4％(159/541)的初级职称医生采用的主要方式为“请教上级医生”.社区医生认为影响诊疗水平提高的原因为“工作忙无暇学习”的占30.1％(257/855),“难以得到专家的实际指导”的占28.3％(242/855),此外认为“相关指南新知识难以掌握理解”者占13.5％(115/855),“外出参加学术会议机会少”者占13.1％ (112/855).社区医生认为日前常规培训存在的主要问题是“与临床实际联系不够”、“授课时间或地点安排不合理”.结论常规培训课程是社区医生获取慢性病防治知识的主要途径,但现有的培训模式和内容等都需要改进.
목적 료해절강성사구의생대만성비전염성질병방치지식적획취도경、수구이급해결림상의난문제적주요방식,분석영향사구의생장지식전화위림상진치능력적인소.방법 2011년1월지2012년12월,대삼가절강성과기청공익성기술응용연구계화항목《고혈압사구공제기술대심혈관병인군방치기지건설적영향연구》기층의생배훈적891명사구의생,진행유관만성병지식적획취도경이급처리림상의난문제적방식、목전상규배훈존재적문제화영향자신능력제고적인소등내용적문권조사.결과 회수유효문권855빈.855명사구의생중,35.2％(301/855)선택“상규배훈과정”시획취만성병방치지식적주요도경,기차시열독전업기간서적(17.8％,152/855)화상급의생지도(17.2％,147/855)；불동급별의원、불동직칭적사구의생획취지식도경불동,조간비교차이유통계학의의(P＜0.05).당사구의생재만성병방치림상공작중우도문제시,36.5％(23/63)적고급직칭의생상용적해결문제방식위“사간교과서적혹기간”,기차시“사간유관질병적진료지남”자점31.7％(20/63)；27.1％ (68/251)적중급직칭의생화29.4％(159/541)적초급직칭의생채용적주요방식위“청교상급의생”.사구의생인위영향진료수평제고적원인위“공작망무가학습”적점30.1％(257/855),“난이득도전가적실제지도”적점28.3％(242/855),차외인위“상관지남신지식난이장악리해”자점13.5％(115/855),“외출삼가학술회의궤회소”자점13.1％ (112/855).사구의생인위일전상규배훈존재적주요문제시“여림상실제련계불구”、“수과시간혹지점안배불합리”.결론 상규배훈과정시사구의생획취만성병방치지식적주요도경,단현유적배훈모식화내용등도수요개진.
Objective To survey the learning resources of knowledge and problem solving of chronic disease prevention and treatment in community physicians.Methods A questionnaire survey was carried out among 891 community physicians who attended the Training course of Hypertension Community Control Technology from January 2011 to December 2012 in Zhejiang Province; to survey the influencing factors of their clinical ability and the problems of routine training.Results Total 855 effective questionnaires were returned.The main findings:35.2％ (301/855) obtained the knowledge of chronic disease diagnosis and treatment from routing training courses,17.8％ (152/855) from reading professional books and 17.2％ (147/855) from the guidance from senior doctors.Different level hospitals and community doctors knowledge acquisition ways of title was different,and there was a statistically difference between them (P ＜0.05).When encountering clinical problemn,36.5％ (23/63) senior physicians would seek answer from professional books and 31.7％ (20/63) from clinical guidelines; 27.1％ (68/251)doctors with middle title and 29.4％ (159/541) junior doctors would mainly consult senior doctors.30.1％(257/855) doctors thought heavy work load prevented them from further improvement of clinical skills,28.3％ (242/855) attributed it to difficulty to obtain advices from experts,13.5％ (115/855) attributed to difficulty in understanding the clinical practice guidelines,and 13.1％ (112/855) attributed to less opportunity to attend professional conferences.The main defects of routine training were the contents not relevant to clinical practice,training time and place inappropriate.Conclusions Routine training is the leading way for primary care physicians to get professional knowledge about chronic disease,but the existing training mode and content need to be improved.