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基于专科医师态度和建议的“专科—全科团队”建设模式探索
发布人：yaot 发布时间：2024/1/5 16:14:40 浏览次数：1028次
——宋景晨 李远萌 姚德明 吴锁薇 盖媛媛 潘琦
【摘要】目的 调研专科医师对“专科—全科团队”（专全团队）的态度和建议，为完善专全团队建设提供参考。方法 对北京市某医院医联体核心和成员单位的348名专科医师进行问卷调查，采用SPSS 19.0软件进行数据统计分析。结果 专科医师对分级诊疗和专全团队的态度较为积极。超过九成的专科医师愿意下转患者及接收上转患者；接近九成的专科医师认为专全团队可以完全或部分解决全科医师医疗服务能力不足问题。专科医师更愿意按照专业组建专全团队，更愿意同期参加一个到两个专全团队，更愿意获得一定的劳动报酬，更愿意进行学科进展、最新诊疗指南解读和病例讨论等培训，更愿意进行定期线上或线下例会总结，更愿意担任兼职领导者，带领5人～10人的专全团队。结论 专科医师对分级诊疗和专全团队模式的态度有利于专全团队模式进一步发展。以学科为基础组建专全团队，以适中的团队规模和工作强度为主，以一定的劳动报酬支持为主，进一步加强专全团队沟通，是完善专全团队建设模式的工作重点。
【关键词】专科—全科团队；专科医师；建设模式；分级诊疗
中图分类号：R197.32；R197.62 文献标识码：A
Construction Mode of a "Specialty-General Practice Team" Based on the Attitude and Suggestions of Specialists/SONG Jingchen,LI Yuanmeng,YAO Deming,et al.//Chinese Health Quality Management，2023,30(12):33-38
Abstract Objective To investigate the attitude and suggestions of specialists toward a "specialty-general practice team", and to provide a basis for improving the construction of a specialty-general practice team.Methods A questionnaire survey was conducted among 348 specialists from the medical association of a hospital in Beijing. SPSS 19.0 software was used for statistical analysis.Results The specialists had a positive attitude towards the hierarchical diagnosis and treatment and specialty-general team. More than 90% of specialists were willing to transfer patients down and accept patients up. Nearly 90% of specialists believed that the specialty-general practice team could completely or partially solve the problem of inadequate medical service capacity of general practitioners. Specialists were more willing to set up specialty-general practice teams according to their specialties, participate in one or two specialized teams at the same time, were more willing to receive certain labor remuneration, were more willing to conduct training on disciplinary progress, interpretation of the latest diagnosis and treatment guidelines and case discussion, were more willing to conduct regular online or offline regular meetings, and were more willing to serve as part-time leaders to lead a specialty-general team of 5 to 10 people.Conclusion The attitude of specialists towards hierarchical diagnosis and treatment and the specialty-general practice team team model are helpful to the further development of the specialty-general practice team mode. It was the focus of the work to improve the specialty-general team construction mode to set up the specialty-general team on the basis of discipline, give priority to the moderate team size and work intensity, give priority to the certain labor remuneration support, and further strengthen the communication of the specialty-general team.
Key words Specialty-General Practice Team; Specialist;Construction Mode; Hierarchical Diagnosis and Treatment
Firstauthor's address Medical Department,Beijing Hospital,National Center of Gerontology;Institute of Geriatric Medicine, Chinese Academy of Medical Sciences,P.R.China,Beijing,100191,China
我国自2015年起全面推进分级诊疗制度建设，《国务院办公厅关于推进分级诊疗制度建设的指导意见》（国办发〔2015〕70号）明确提出，到2020年要逐步形成基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式。建立分级诊疗制度是深化医药卫生体制改革的一项重要内容［1］。双向转诊是分级诊疗政策实施过程中的重要环节，也是合理分配医疗资源的重要举措［2-4］。医联体在实现优质医疗资源下沉，均衡资源配置，完善分级诊疗制度等方面发挥了重要作用［5-6］。基层医疗卫生服务机构在提供医疗保健等方面扮演着重要角色，是分级诊疗与双向转诊的重要环节，但其服务能力不足是推行分级诊疗和双向转诊的主要障碍之一［7-9］。“专科-全科团队”（以下简称“专全团队”）是提高全科医师和基层医疗卫生服务机构诊疗能力的重要形式之一，可以充分发挥专全团队作用，促进全科医师诊疗水平提升，从而使基层医疗卫生服务机构更好地为群众提供医疗卫生服务，进一步推进双向转诊和分级诊疗政策落实［10］。专科医师是专全团队的重要组成部分，对提高全科医师的诊疗能力发挥着决定性作用。本研究通过调研专科医师对专全团队的态度和建议，旨在优化专全团队建设，提高专全团队运行效率，进一步加强全科医师和基层医疗卫生服务机构的医疗服务能力，更好地落实分级诊疗政策。
1研究对象与方法
1.1研究对象
以北京市某医院医联体为主要调查范围，选择医联体内二级、三级医院自愿参加本调查的348名专科医师作为研究对象。
1.2研究方法
设计调查问卷，内容分为前言和主体两部分。前言部分包括调查目的和知情同意。主体部分包括：（1）研究对象基本情况；（2）对分级诊疗的态度和参与情况；（3）对专全团队的态度和参与情况；（4）对专全团队的建议。问卷初稿设计完成后，邀请参与过医联体工作的专家进行修改，并组织10名专科医师预填写，根据专家意见和预填写情况修改问卷。修改内容包括：对“在工作中是否接收全科医师转诊的患者”问题增加多选选项，细化患者来源和未接收原因，方便数据分析和使用；对封闭式题目设置必填项，保证问卷填报质量。由北京市某医院医联体核心单位统一发放调查问卷，使用问卷星收集数据并导出。
1.3统计分析方法
采用Office Excel 2010软件进行数据录入，计数资料的统计描述采用率或构成比。采用SPSS 19.0软件进行统计分析，两组或多组率间比较运用卡方检验、Fisher精确检验，组间两两比较通过交叉列表的角标表示结果，检验水准设为0.05。
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