浙江省社区医生获取慢性病防治知识途径及解决临床疑难问题方式调查

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I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）。社区医生认为目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。

Survey on learning resources of knowledge and problem solving of chronic diseases prevention and treatment in community physicians of Zhejiang Province

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.