三级综合医院全科医学科病房收治病种情况及其对全科医生能力培养的价值

背景　自20世纪80年代全科医学科进入中国内地以来，在政府对基层卫生服务及全科医学的高度重视下，我国全科医学已经有了一定发展，大部分综合医院已设置全科医学科，但其角色定位及全科医生培养发挥作用仍处于探索阶段。目的　统计全科医学科病房收治病种情况，通过其顺位来分析三级综合医院全科医学科病房在全科医生能力培养方面的优势，探索其角色定位。方法　通过深圳市龙华区中心医院信息中心统一调取2017年9月-2019年12月在全科医学科病房住院的1 728例次患者的电子病历，回顾性分析患者的一般情况、出院诊断及转归情况。结果　1 728例次全科医学科住院患者包括261个疾病种类，按系统分类就诊例次最高的疾病系统为呼吸系统〔379例次（21.93%）〕，其次分别为循环系统〔272例次（15.74%）〕、内分泌系统〔242例次（14.00%）〕、消化系统〔182例次（10.53%）〕、神经系统〔152例次（8.80%）〕。就诊人次最高的前10位疾病分别为肺炎、2型糖尿病、高血压、脑梗死、心脏神经官能症、支气管炎、甲状腺功能亢进症、急性胃肠炎、糜烂性胃炎、心律失常，共803例次（46.47%）。2017、2018、2019年每年排在前3位的疾病均为高血压、肺炎、2型糖尿病，其中2017年，高血压30例次（15.79%）、肺炎24例次（12.63%）、2型糖尿病22例次（11.58%）；2018年，肺炎83例次（10.30%）、高血压71例次（8.81%）、2型糖尿病70例次（8.68%）；2019年，肺炎113例次（15.44%）、2型糖尿病82例次（11.20%）、高血压64例次（8.74%）。出院诊断患1种疾病者93例次（5.38%），合并2种或2种以上慢性病者1 635例次（94.62%）。经全科诊治后，病情好转或治愈下转社区健康服务中心627例次（36.28%）。结论　三级综合医院全科医学科住院患者病种包括各个系统常见病、多发病，疾病种类与社区相似。通过对收治病种顺位分析，提示综合医院全科医学科有利于全科医生掌握常见病、多发病诊治及慢性病管理技能，能有效地锻炼全科思维理念，有助于培养更能胜任社区全科诊疗工作的全科医生。

Capacity for General Practitioner Training of General Practice Department in Tertiary General Hospitals:a Study Based on the Disease Profile Analysis of General Medical Inpatients

Background General practice has obtained some developments in China since its introduction in the 1980 s,with priority initiatives taken by the government.Most general hospitals have set up a general practice department,but the roles of the department,including its role in training general practitioners(GPs)are still under exploration.ObjectiveTo explore the roles of general medical ward in a tertiary general hospital,including its role in training GPs,by analyzing the disease profile in general medical inpatients.Methods Retrospective analysis of the general conditions,discharge diagnosis and resettlement of 1728 patients admitted to the General Medical Ward,Longhua District Central Hospital,Shenzhen,from September 2017 to December 2019,through Shenzhen Longhua District Central Hospital Information Center.Results Among the totaled 261 types of diseases suffered by the included inpatients,respiratory system diseases were the most reason for visits379 cases(21.93%)],followed by circulatory system diseases272 cases(15.74%)],endocrine system diseases242 cases(14.00%)],digestive system diseases182 cases(10.53%)],nervous system diseases152 cases(8.80%)].The top 10 in terms of number of visits were pneumonia,type 2 diabetes,hypertension,cerebral infarction,cardiac neurology,bronchitis,hyperthyroidism,acute gastroenteritis,rotified gastritis,and arrhythmia,with a total of 803 cases(46.47%).The top 3 diagnoses during September to December 2017 were hypertension30 cases(15.79%)],pneumonia24 cases(12.63%)],and type 2 diabetes22 cases(11.58%)].They remained the top 3 in 201883 cases of pneumonia(10.30%),71 cases of hypertension(8.81%)and 70 cases of type 2 diabetes(8.68%)],and in 2019113 cases of pneumonia(15.44%),82 cases of type 2 diabetes(11.20%)and 64 cases of hypertension(8.74%)].93 patients(5.38%)were diagnosed with one disease at hospital discharge,and other 1635(94.62%)with 2 or more chronic diseases.After general treatment,627 cases(36.28%)who were improved or cured were transferred to community hospitals for community-based rehabilitation.Conclusion The disease profile of patients treated in general medical ward of the tertiary general hospital covers common diseases of various systems,and frequently-occurring diseases,and the types of diseases are similar to those suffered by patients treated in community care.This analysis indicates that the establishment of general practice department in general hospitals helps GPs to master the diagnosis and treatment of common diseases and frequently-occurring diseases as well as the management of chronic diseases and effectively develop ideas of general practice,and contributes to the cultivation of qualified GPs performing general care in the community.