加强全科医生队伍建设的思考与建议

通过对我国全科医生队伍建设现状的分析,探究了制约全科医生队伍建设的原因,提出要从全科医生培养、使用、吸引等关键环节着手,系统设计我国全科医生制度,以规范化培养为核心,建立健全多渠道、多层次的全科医生培养体系,同时提高全科医学专业地位和吸引力,加强全科医生培养能力建设,促进全科医生队伍不断发展壮大.     

全科医学教育与社区卫生服务现况分析与对策

通过介绍国内外全科医学的起源、发展,全科医生在社区卫生服务中的地位和作用以及目前我国社区卫生服务人力资源存在的问题,揭示发展全科医学教育、培养全科医生的重要性和迫切性;探讨适合中国国情的全科医学教育模式。     

社区卫生服务中全科医生人才培养途径探索

为了解决居民看病难、看病贵的问题,建立社区卫生服务中心、实行全科医生制已经成为我国卫生体制改革的重要举措。全科医学人才的培养是专业化的基层卫生人才队伍建设的关键环节,是社区卫生服务工作的一项迫切任务。将对我国全科医学人才培养的现状进行深入分析,找出存在的主要问题,结合我国自身特点和实际需求,探索一条具有中国特色的社区全科医学人才培养之路。     

从国情出发对我国全科医学发展现状的探析和方向的思考

结合我国国情,通过对全科医学发展现状和存在问题的剖析,在适应现阶段医疗卫生事业深入改革的大背景下,为寻求提高我国全科医学发展水平的、更好地发挥全科医生基础医疗作用的、满足我国全科医学发展要求的学科改革方向提供思路和参考。     

公共健康视域下全科医生健康管理与指导能力的培养

在"健康中国2030"发展规划和"大健康、大卫生"理念的指导下,建立全科医生培养制度,对我国公共卫生事业的发展起着重要作用。培养全科医生健康管理与指导能力,旨在提高全科医学人才的基层工作能力和健康治理水平。鉴于此,本文从医学、体育学、心理学等相关交叉学科视域探寻全科医生的培养策略,旨在培养全科医生的健康管理与指导的综合能力,以更好地为基层医疗单位输送优秀全科医学人才。     

我国基层医疗卫生机构全科医生队伍建设现状

目的 探讨我国基层医疗卫生机构全科医生队伍建设的现状,提出基层医疗卫生机构全科医生队伍建设的一些建议。方法 采用文献研究法,同时结合笔者多年从事基层全科医学工作的实践经验,分析了基层医疗卫生机构全科医生队伍建设的重要性和必要性。结果 我国基层医疗卫生机构全科医生缺口比较大,必须加快全科医生队伍建设。结论 建立一支能够胜任基本医疗卫生工作的卫生队伍迫在眉睫。     

金科医生与农村社区卫生服务

1 培养全科医生是开展社区卫生服务的前提全科医学是以传统生物医学整合的心理与行为医学和社会学及其他相关科学理论而形成的一个新型医学体系,与内科、外科、妇产科、儿科等学科并列为二级学科.有人认为,过去的乡村医生本身就是全科医生,其从事的工作就是社区卫生服务,这种观点是片面的.只有接受了全科医学教育,才能成为全科医生."全科”的含义是指在社区进行医疗、预防、保健、康复等工作,是不分科的.全科医学的理论体系和实践服务要求全科医生是对全人、全科、全程、全生命用全心进行服务.全科医生整体队伍状况成为影响社区卫生服务的主要因素.     

美国的全科医生教育及医疗服务现状

全科医学是近 30年来迅速发展起来的一门新学科。 1997年《中共中央、国务院关于卫生改革和发展的决定》指出 ,要“加快发展全科医学、培养全科医生”,以适应我国新形势下卫生改革的需要。为使更多的读者能进一步了解全科医学 ,本文重点介绍美国医疗服务现状及全科医学教育。1　全科医生医疗服务现状1.1　全科医生医疗服务内容美国的全科医生是一个家庭或一个团体的健康维护者 ,能提供健康咨询、预防保健、医疗康复和常见病的诊断治疗等长期服务 ,并对慢性病人和康复期病人主动追踪观察。他们必须能够处理病人的 85— 90 %的健康问题。许多…     

现阶段我国全科医生培养模式探讨

全科医生的培训是我国现阶段社区卫生服务发展的当务之急。本文对目前国内几种全科医生培养模式进行了分析，探讨适宜我国国情和教育现状的全科医生培养模式，以促进我国全科医学教育和社区卫生服务的健康、稳定发展。     

英国全科医学模式对提升我国基层卫生服务能力的启示

目前我国乡镇、社区医院的功能正在转型、升级,如何提升全科医生队伍的服务能力是摆在我们面前的难题。本文通过我国与英国全科医学建设"人-财-物"三方面的比较,得出培养全科医学人才、提升卫生绩效、建设信息平台等方面的启示。     

基层社区卫生服务机构全科医生执业注册情况及规范化培训意向分析

目的:分析基层社区全科医生执业情况和规范化培训意向,提出促进全科医师培养的政策建议。方法:对3省15个社区机构297名医生现场问卷调查,对医生执业情况和培训意向进行描述性分析。结果:基层社区医生人员结构有所优化,但社区医师实际注册全科医师的比例低,基层全科医师岗位培训有待规范。结论:规范化培训和岗位培训相结合,多渠道培养全科医师;完善注册政策,提高全科医生待遇、社会地位,提高全科医师注册比例;进一步规范全科岗位培训和加强医改相关政策宣传。     

全科医生团队建设实践与构想

文章简单介绍了国外全科医生团队的发展情况以及国内各地开展全科医生团队服务模式的实践情况,并分析了目前全科医生团队建设存在的主要问题,进而提出了有关建设全科医生团队的一些构想。     

我国综合性非营利医院职能科室中层管理人员现状分析

目的 通过对我国综合性非营利医院管理队伍现状及素质要求的调查，提出医院管理职业化措施。方法 采取多阶段分层整群随机抽样的方法进行调查。结果 我国综合性非营利医院职能科室中层管理人员存在整体素质不高、管理制度与职业化意识缺乏等主要问题。结论 医院管理队伍的现状与职业化管理有相当的距离，应从管理培训人手，建设一支专业化的医院管理队伍，健全各项制度，推进医院职业化管理队伍的建设。     

全科医生执业及服务方式的国际经验与启示

本文比较了部分典型国家和地区全科医生的执业及服务方式,发现全科医生执业以自雇为主、多种雇佣形式并存;以自由多点执业为主、固定执业为补充;服务方式从单独服务向跨专业联合团队服务过渡。启示:全科医生自由多点执业需要一定的社会环境和条件,组建跨专业的联合团队正在成为全科医生服务方式的发展方向,不同卫生体制国家全科医生在建立转诊制度中的作用不同。建议:创造多元、宽松的执业环境,为全科医生执业方式转变提供条件;加强多学科服务团队建设,推动全科医学服务方式在社区的转变;通过医保基金调控,逐步建立"守门人"制度,实现分级诊疗;鼓励社会力量举办全科医学服务机构,促进健康服务产业发展。     

荷兰医改及对我国构建整合型健康服务体系的启示

本文介绍了荷兰卫生服务体系概况,重点阐述了荷兰新医改后的全科医生首诊制度、"有管理的竞争模型"健康保险体系、长期照护体系典型政策范例。借鉴荷兰改革经验,提出推进我国卫生服务体系整合实践的策略。建议:以提高全科医生职业吸引力作为改革起点,全科医生队伍建设先行,筑牢改革根基;立法先行、以市场机制作为改革抓手,搭建公共政策规制与市场激励相容的改革框架,形成一套富有管理的、有竞争性、有活力的中国健康保险体系;在积极健康老龄化背景下,以整合理念建设适合我国国情的老年人长期照护体系;承接我国移动互联领域的资源基础,依托智慧治理破解医改难题。     

Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany

BACKGROUND: General practitioners (GPs) can contribute substantially to the promotion of smoking cessation in the general population. However, engagement of GPs in helping their patients to quit remains very limited in many countries, including Germany. Therefore, new strategies to foster implementation of evidence-based methods in smoking cessation assistance have to be identified, and data for current practice of and barriers against smoking cessation promotion in general practice are needed. METHODS: A cross-sectional survey among all 657 general practitioners practising in the Rhein-Neckar Region of Germany was conducted in spring 2002 using a postal questionnaire (response rate 48%). RESULTS: The majority (54%) of GPs reported having treated less than 10 patients for smoking cessation (by any means including mere advice to quit) within the last three months, 23% of GPs never received any education or training in smoking cessation promotion, and only one-third of GPs rated their training as adequate. The factor most strongly associated with low activity in smoking cessation promotion (defined as having treated less than 10 patients within the last three months) was perceived lack of training (odds ratio 2.70, 95% confidence interval 1.68 - 4.32), followed by perceived lack of demonstration material (2.10, 1.31 - 3.39) and perceived lack of time (1.65, 1.02 - 2.66). Furthermore, there was a clear dose-response relationship between the time spent on training and the activity in smoking cessation promotion. CONCLUSION: Adequate training may be a key factor to enhance engagement of general practitioners in the promotion of smoking cessation.     

Collaborative work by using videoconferencing: opportunities for learning in daily medical practice

In this article, I explore what happens when general practitioners (GPs) and specialists meet using videoconferencing to collaborate on a patient's treatment. By using videoconferencing, GPs and specialists are offered opportunities to share and produce knowledge. The data corpus was 42 videotaped videoconferences. The treatment of one specific patient was selected.This patient was discussed over a period of 9 days, which constituted five videoconferences. I describe how GPs and specialists discuss treatment strategies and exemplify how knowledge sharing creates opportunities for learning in boundary zones across activity systems as a part of daily practice.The talk about the treatment occurs by information exchange and by consultation. Information exchange without any dilemmas presented might support decisions already made. Consultations wherein dilemmas are presented and solved by bridging knowledge gaps between the general practitioner and the specialist create opportunities for learning.     

Nurse practitioners in primary care

OBJECTIVES: Recent policy emphasizing the role of primary care has increased the workload of general practitioners (GPs) while simultaneously placing nurse practitioners (NPs) as key providers in the delivery of health care. There is need to examine the latter's work practices. The purpose of this article is to explore the role and practice of NPs in general practice. METHODS: DESIGN: Thirty-six semi-structured interviews with GPs, NPs, receptionists and patients were analysed. SETTING: Four general practices in south-east England. MAIN OUTCOME MEASURES: Data from semi-structured interviews relating to allocation, prescribing and referral practices of NPs in primary care. RESULTS: These include the differences in presenting problems of patients seen by GPs and NPs, prescribing and referral practice and legal issues of the nurse practitioner. A wide range of practice is reported. CONCLUSION: This study highlights the variation in how patients are allocated for NP consultation and in NP autonomy, prescribing and referral, which raises issues for clinical governance of protocols and risk management.     

Barriers to developing the nurse practitioner role in primary care-the GP perspective

BACKGROUND: Opportunities exist to develop an advanced nursing role in general practice and there is growing evidence that appropriately trained nurses can reduce cost and GP workload without compromising quality of care or patient satisfaction. Despite the shortfall of doctors entering British general practice and the difficulties doctors report in managing an increasing workload in primary care, few British practices have chosen to adopt this potential solution. An exploration of the barriers to the development of a nurse practitioner role is therefore timely. OBJECTIVE: To explore the views of British GPs regarding their attitudes towards developing an advanced nursing role in general practice. METHODS: A focus group study of GPs from four general practices in Yorkshire selected purposefully to represent a spectrum of experience in working with different nursing roles in general practice. Each focus group consisted of between 6 and 8 participants. A structured framework was used to elicit views, the group meetings were recorded and subjected to content analysis by two independent assessors. Inter-rater reliability was high (K = 0.921; 95% confidence limits 0.86-0.98). RESULTS: The study highlighted significant concerns by GPs with regard to the nurse practitioner role in general practice. Four themes were identified that may be impeding the development of advanced nursing roles in general practice. These are concerned with threats to GP status, including job and financial security, nursing capabilities, including training and scope of responsibility, and structural and organizational barriers. CONCLUSIONS: There is a need to acknowledge GP concerns and encourage a more widespread debate about the appropriate mix of skills required in primary care. Joint educational events and the development of GP preceptorship may help to develop a greater understanding of the potential value of advanced nursing roles in general practice.