新医改完善医疗服务体系中28个省市部分临床医生职业观点调查

摘要

目的:通过对我国部分省市临床医生的职业观点开展调查研究和综合分析,以为构建城市新型医疗服务体系提供科学路径.方法:以文献回顾法和专家访谈法,设计调查问卷.调查了28个省市648名临床医生对专业能力、慢性病诊治和管理的认识,对职前和在职医学教育的评价,以及对医生职业发展与医疗服务整合的观点和认识. 结果:被调查者具有不同程度的临床经历,分布在各级医疗机构,具有良好的代表性.其中,认为目前专业知识和临床技能基本或完全可以应对接诊患者的比例不高(57.3％),尽管,60％以上的医生认为常见慢性疾病应该在社区诊治、随访和管理,但这些患者目前仍占大医院的专科门诊的很大比重(60％以上占54.4％).仅24.4％的临床医生认为医学院校接受的课程在临床诊治常见病和慢性病时基本可以胜任.74.4％的被调查医生需要在毕业后继续教育中学习这些常见病的诊治技术.超过60％的医生认为目前医院与社区间缺乏专业合作渠道和机制.2/3的医生觉得非常必要全面加强医院专科和社区慢性病管理的合作.结论:健康服务模式和医学教育必须适应社会疾病谱的变化和疾病防治的需求.%Objective: To improve health delivery system of new health reform in China, pay attention to the primary health care in community and chronic diseases , and to give the evidence pathway to new health delivery system in urban area, we studied and analysed the occupational views of physician in China. Methods: Based on literatures review and experts interview, we designed a questionnaire and studied the views of 648 physicians who from 28 provinces and cities. These questions focused on clinical knowledge and skill, view of chronic disease care and management, effect evaluation of medical education before and after graduation, attitudes of health care cooperation and service integration. Results: These physicians with different clinical experiences, and work in different hospitals and communities. They are good samples for this study. 57.3% physicians believed that their knowledge and skill can cope with patients, although 60% doctors thought that chronic diseases can be cared in community, the ratio of these patients still was higher in specialist outpatient department (more than 60% is 54.4%). Only 24.4% physicians believed that the knowledge and skill which learn in medical school was useful to chronic diseases care. There are 74.4% doctors have to learn and renew these knowledge and skill in continue medical training courses after graduation. More than 60% people thought that there less cooperation and pathway between hospital and community in chronic diseases care. They enhance the professional cooperation and service integration. Conclusions: Health care model and medical education must suit to need of the disease care and prevention. We have to integrate the medical courses between hospital and medical school, map out effective strategy of medical education in chronic diseases and regular diseases care. The professional cooperation between hospital and community should play more important role in the field.