我国基层医疗卫生机构发热诊室设置与利用情况调查研究

背景　新型冠状病毒肺炎（简称新冠肺炎）疫情防控期间，基层医疗卫生机构发热诊室设置是一项重要的经验总结与尝试，目前发热诊室试点工作已开展一年有余，分析其运行情况十分必要。目的　调查基层医疗卫生机构发热诊室的设置与利用情况，总结经验并提出相应建议。方法　于2021-02-22至2021-03-02，采用多阶段抽样法，选取基层医疗卫生机构（社区卫生服务中心/乡镇卫生院）全程参与新冠肺炎疫情防控工作的主要负责人员开展问卷调查，调查其所在机构是否开设了发热诊室〔包括疫情防控期间设置的发热（哨点）诊室和疫情防控前设置的发热门诊〕，以及累计使用时间、累计接诊人次、累计转诊率、累计确诊人次。结果　最终回收有效问卷718份，来自408家基层医疗卫生机构。其中，在新冠肺炎疫情防控期间开设了发热诊室的机构208家（51.0%），在新冠肺炎疫情防控之前已开设的机构91家（22.3%），一直未开设的机构109家（26.7%）。271例应答者参与了发热诊室工作。根据该271份问卷：截至2021年1月底，发热诊室的中位累计使用时间为12（10）个月；188例（69.4%）应答者表示累计接诊人次<300人次，45例（16.6%）应答者表示累计接诊人次>1 000人次；184例（67.9%）应答者表示累计转诊率<3%，35例（12.9%）应答者表示累计转诊率>70%；238例（87.8%）应答者表示接诊的所有患者中最终确诊为新冠肺炎的人数为0例。χ2检验结果显示：新冠肺炎疫情防控期间开设发热诊室与疫情防控之前开设发热诊室的累计接诊人次比较，差异有统计学意义（P<0.05）；但不同地区（包括按经济带划分、按本城市内地理位置划分、按所属地区疫情期间最高风险等级划分）发热诊室的累计接诊人次、累计转诊率、累计确诊人次比较，差异无统计学意义（P>0.05）。Spearman秩相关分析结果显示，发热诊室的设置时间与累计使用时间、累计接诊人次呈正相关（rs值分别为0.37、0.18，P<0.05），按经济带划分地区（东、中、西部）与累计确诊人次呈正相关（rs=0.13，P<0.05）。结论　超2/3的基层医疗卫生机构在新冠肺炎疫情防控期间或之前设置了发热诊室/门诊。不同地区因素的发热诊室在累计接诊人次、累计转诊率、累计确诊人次方面无明显差异。新冠肺炎疫情防控之前开设发热门诊的接诊工作量高于新冠肺炎疫情防控期间设置的发热（哨点）诊室，表明基层医疗卫生机构具有一定处置发热患者的工作潜力。

Survey Research on the Setting and Utilization of the Fever Clinic at Primary Healthcare Institutions

Background　During the prevention and control of the COVID-19，the setting of fever clinic in primary healthcare institutions is an important experience summary and pilot practice. At present，the pilot sentinel surveillance has been carried out for more than one year，and it is necessary to analyze its operation situation. Objective　To investigate the setting and utilization of fever clinic in primary healthcare institutions，summarize experience and put forward corresponding suggestions. Methods　From 2021-02-22 to 2021-03-02，a multi-stage sampling method was adopted to select primary healthcare institutions（community healthcare centers/township health centers） who participated in the prevention and control of the COVID-19 epidemic to conduct a questionnaire survey（including fever sentinel surveillance clinics set up during epidemic prevention and fever clinics set up before epidemic prevention），cumulative use time，cumulative number of visits，cumulative referral rate，and cumulative number of diagnoses. Results　718 valid responses from 408 primary healthcare institutions were totally obtained. Among them，208 institutions（51.0%） set up fever sentinel surveillance clinic during the prevention and control of the COVID-19 epidemic，91 institutions（22.3%） had set up before the prevention and control of the COVID-19 epidemic，and 109 institutions（26.7%） had not set up. 271 subjects participated in the work of the fever sentinel surveillance clinic. According to the 271 questionnaires：as the end of January 2021，the median cumulative use time of the fever sentinel surveillance clinic is 12（10） months；188 cases（69.4%） of the respondents indicated that the cumulative number of visits was <300，and 45 cases（16.6%） indicated that the cumulative number of visits was >1 000；184（67.9%） respondents indicated that the cumulative referral rate was <3%，and 35（12.9%） respondents indicated that the cumulative referral rate was >70%；238（87.8%） of the respondents indicated that the number of patients who were finally diagnosed with novel coronavirus pneumonia was 0 out of all the patients admitted. The test results of χ2 showed that the cumulative number of visits between the setting of the fever clinic during the prevention and control of the novel coronavirus pneumonia epidemic and the setting of the fever clinic before the epidemic prevention and control is statistically significant（P<0.05）；However，there is no statistically significant difference in the cumulative number of visits，the cumulative referral rate，and the cumulative number of diagnoses in fever clinic in different regions（including economic zone，geographical location within the city，and the highest risk level during the epidemic period of the region）. The results of Spearman rank correlation analysis showed that the setting time of fever clinics was significantly positively correlated with cumulative use time and cumulative visits（rs values were 0.37，0.18，P<0.05），and the region（east，central，and western） was significantly positively correlated with cumulative diagnoses（rs=0.13，P<0.05）. Conclusion　According to the survey，more than two thirds of primary healthcare institutions in China have set up fever sentinel surveillance clinics/fever clinics，and of which no difference were indicated in the cumulative visit number of febrile patients，cumulative referral rate and cumulative number of confirmed COVID-19 infections based on the different economic zones，geographical locations and regions with different highest risk level. The higher cumulative number of visits to fever clinics than fever sentinel surveillance clinics demonstrated the potential capacity of managing patients with fever during the pandemic of infectious diseases.