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目的:提高乡村两级医生业务知识和技能,提高儿童家长防病知识知晓率,促进卫生服务利用率。方法:以2个项目县8个乡的0~3岁儿童为研究对象,分6个试点乡和2个对照乡。课题实施前后均进行儿童疾病情况、家长育儿知识、防病知识调查,课题实施期间省县级专家定期下乡村督导、现场考评和质量控制。在试点乡使用儿童综合诊治与管理诊疗常规、农村儿童疾病综合诊治与管理门诊病历本、《农村儿童疾病综合诊治与管理工作手册》培训乡村医生,让乡卫生院、村卫生站医生以填写门诊病历方式进行儿童综合诊治与管理,开展以面对面人际交流为主的健康教育。结果:①儿童家长的科学育儿及防治疾病知识得以普及和提高,如知道小儿腹泻、营养性贫血、营养不良的临床表现分别提高57.5、46.7和49.6个百分点;②儿童健康状况有所改善:小儿生长迟缓、营养性贫血、营养不良分别下降22.8、19.4和7.8个百分点;③乡村两级医生业务知识和技能有较大提高:乡级医生综合知识考核结果优良占75.0%,大于基调35.7%,高于对照乡25.0%。结论:开展儿童疾病综合诊治与管理有利于提高乡村两级医生业务知识、技能,普及科学育儿知识,促进卫生服务利用率,改善儿童健康状况。
OBJECTIVE: To improve the operational knowledge and skills of doctors at village and village levels, raise the awareness rate of children’s disease prevention knowledge and promote the utilization of health services. Methods: The children aged 0 ~ 3 in 8 townships of 2 project counties were divided into 6 pilot villages and 2 control villages. Before and after the implementation of the project, children’s disease status, parental care knowledge and disease prevention knowledge survey were conducted both before and after the implementation of the project. During the project implementation, provincial and county-level experts regularly supervise the countryside, conduct on-site evaluation and quality control. In the experimental township, children’s comprehensive diagnosis and treatment of routine use of diagnosis and treatment, comprehensive diagnosis and treatment of rural children with outpatient medical records, “rural children’s disease diagnosis and management manual” training rural doctors, rural hospitals, village health station doctors to fill out the clinic Medical records approach to comprehensive diagnosis and treatment of children, to carry out face-to-face interpersonal communication-based health education. Results: (1) The knowledge of childcare and disease prevention and control of children’s parents has been popularized and improved. The clinical manifestations of children with diarrhea, nutritional anemia and malnutrition increased by 57.5, 46.7 and 49.6 percentage points respectively; (2) Children’s health improved: Growth retardation, nutritional anemia and malnutrition decreased by 22.8, 19.4 and 7.8 percentage points respectively; (3) The professional knowledge and skills of doctors at village and village level were greatly improved: the results of comprehensive knowledge assessment of township doctors accounted for 75.0%, which was 35.7% 25.0% higher than the control township. Conclusion: To carry out comprehensive diagnosis, treatment and management of children’s diseases is beneficial to improve knowledge and skills of doctors at village and village levels, popularize scientific childcare knowledge, promote utilization of health services and improve children’s health.