论文部分内容阅读
目的:探讨现阶段基层医疗卫生机构在慢性呼吸系统疾病（慢性阻塞性肺疾病、支气管哮喘、阻塞性睡眠呼吸暂停）管理中存在的问题，并提出建议。方法:于2018年11月21—22日，选取北京市密云区全部19家社区卫生服务中心（简称“中心”）及来自4家中心的65名全科医生参与调研。采用自主设计的调查问卷，包括《医疗机构现况调查问卷》（简称“机构问卷”）和《全科医生慢性呼吸系统疾病知识调查问卷》（简称“医生问卷”）。机构问卷由密云区卫生健康委员会（卫健委）组织发放，中心负责人填写；医生问卷由密云区卫健委推荐4家中心，通过各中心负责人发放二维码至全部全科医生，全科医生自愿填写。对调查结果进行描述性分析，符合正态分布的计量资料两组间比较用两独立样本n t检验，多组间比较用方差分析。n 结果:向各中心发出19份机构问卷，回收有效问卷19份。其中，18家中心负责人认为慢性呼吸系统疾病应纳入慢性非传染性疾病管理，并应建立健康档案做到定期随访监测，但仅1家中心开展了哮喘建档工作；9家中心已购置肺功能仪；药物配备方面，8家中心配备吸入性糖皮质激素，1家中心仅配备βn 2受体激动剂。知识问卷有效回收率为100.0%（65/65），全科医生对3种慢性呼吸系统疾病（慢性阻塞性肺疾病、支气管哮喘、阻塞性睡眠呼吸暂停）知识回答得分分别为（63±19）、（64±23）、（62±21）分，差异无统计学意义（n F=0.087， n P>0.05）；年龄50 岁全科医生的总得分分别为（57±15）、（66±13）、（42±16）分，初、中、高级职称全科医生的总得分分别为（54±19）、（67±12）、（68±11）分，不同年龄、职称的全科医生知识总得分差异均有统计学意义（n F值分别为8.582、6.079，均n P50岁，初级职称的全科医生平均成绩较低。n 结论:密云区各中心负责人对开展慢性呼吸系统疾病诊治工作的必要性有明确认识，但仍存在对慢性呼吸系统疾病重视程度不足、疾病管理基础设施相关投入不足、全科医生慢性呼吸疾病专业知识缺乏等问题。希望未来能将慢性呼吸系统疾病引入公共卫生服务项目，加强相关疾病基础设施投入，尽早普及适合基层全科医生的、完备的呼吸系统知识能力培训课程。“,”Objective:To investigate the current status of chronic respiratory disease (chronic obstructive pulmary disease, bronchial asthma and obstructive sleep apnea) management capacity in community health centers in Beijing Miyun district.Methods:From November 21 to 22,2018,nineteen community health centers and 65 general practitioners in Miyun district of Beijing were selected to participate in a questionnaire survey. The self-designed questionnaire was divided into two parts: the questionnaire for medical institutions(institution questionnaire)and questionnaire for general practitioners(doctor questionnaire). The institution questionnaires were distributed by the Miyun District Health Commission,and filled in by the person in charge of the institution; the knowledge questionnaires were sent to all general practitioners of 4 community health service centers. The two independent sample n t test was used to compare the measurement data in accordance with normal distribution between the two groups, and analysis of variance was used for multi group comparison.n Results:Nineteen institution questionnaires were sent to all centers in the district and all 19 valid questionnaires were recovered. Among them, 18 centers thought that chronic respiratory diseases should be included in the management of chronic non-communicable diseases, and health records should be established to achieve regular follow-up monitoring, but only one center had put asthma in the record. Nine centers purchased pulmonary function instrument; 8 centers were equipped with inhaled glucocorticoid, and 1 center was equipped with βn 2-receptor agonists. The effective recovery rate of knowledge questionnaire was 100.0% (65/65). There was no significant difference in the knowledge scores of three kinds of chronic respiratory diseases (chronic obstructive pulmary disease, bronchial asthma, obstructive sleep apnea) among general practitioners [(63±19), (64±23), (62±21),n F=0.087, n P>0.05]. The scores of general practitioners with different ages and professional titles were (57±15), (66±13), (42±16) and (54±19), (67±12), (68±11) respectively. There were significant differences in the knowledge scores of general practitioners with different ages and professional titles (n F= 8.582 and 6.079, all n P50 years or junior professional title were lower than others.n Conclusions:The leaders of each center in Miyun district have a clear understanding of the necessity of diagnosis and treatment of chronic respiratory diseases, but there are still some problems, such as insufficient attention to chronic respiratory system, insufficient investment in disease management infrastructure, and lack of professional knowledge of chronic respiratory diseases among general practitioners. It is hoped that in the future, chronic respiratory diseases can be introduced into public health service projects, investment in related disease infrastructure will be strengthened, and comprehensive respiratory knowledge and ability training courses suitable for grass-roots general practitioners can be popularized as soon as possible.