北京市东城区社区医生在实施心力衰竭分级诊疗过程中的教学培训需求调查研究

目的 为推动《心力衰竭分级诊疗的技术方案》在不同医疗机构(三甲医院、二级医院和基层卫生单位)的联动管理,对于北京市东城社区医生在相关培训需求方面进行调研。 方法 依据《心力衰竭分级诊疗的技术方案》设计定量问卷,共47个问题。问卷由东城卫管中心发送至东城社区医生工作群。 结果 共178名社区医生回答了问卷,中位年龄为36岁(32~47岁),中位社区工作年限为10年(5~13年)。88.2%的社区医生愿意长期管理心力衰竭患者。在心力衰竭高危因素管理方面,73.6%的社区医生认为患者已经接受了心力衰竭高危因素的管理。在诊断方面,52.2%的医生没有信心听懂心音。在日常管理方面,最大的问题是缺乏心衰指南的培训(72.5%),导致约有75.8%的医生不能遵照指南用药。此外约有79.8%的医生不能识别心脏辅助装置的适应证。在心衰转诊方面,79.8%的医生不知辖区内有多少心衰患者,75.3%的医生无法与转诊单位的专科医师取得联系,获取转诊患者的诊疗信息。在患者教育方面,突出的问题是患者不能进行良好的容量管理(72.5%)和不遵从医嘱(71.3%)。在转诊方面,92.7%的社区医生希望能够与专科医生以团队合作的方式进行病例讨论。 结论 推动心衰分级诊疗,社区医生需要在心衰诊断,尤其是心衰指南进行培训,加强患者自我管理的教育,建立社区与专科医生之间的转诊和培训平台。 

Investigation on the needs of training of community doctors in the diagnosis and treatment of heart failure in Dongcheng District of Beijing

Objective To investigate the training demand of community doctors Dongcheng District of Beijing in order to promote the linkage management of the "technical scheme for grading diagnosis and treatment of heart failure" in different medical institutions(tertiary hospitals, secondary hospitals and primary health units). Methods According to the technical scheme of grading diagnosis and treatment of heart failure, a quantitative questionnaire was designed, which included 47 questions and were sent to Dongcheng Community doctors working group by Health Management Center. Results A total of 178 community doctors answered the questionnaire, with an average age of 36 years(32-47 years) and 10 years of community service(5-13 years). The percentage of the community doctors willing to take care the patients with heart failure was 88.2%; 73.6% of the community doctors thought that the patients had accepted the treatment of high-risk factors of heart failure; 52.2% of the doctors were not confident heart sounds auscultation. In the daily management of heart failure, the biggest problem was the lack of heart failure guideline training(72.5%), leading to about 75.8% doctors could not follow the guidelines, and about 79.8% doctors could not identify the indications of heart assist devices. In terms of heart failure referral, 79.8% doctors did not know the number of heart failure patients in their community, and 75.3% doctors could not contact the specialists of referral units to obtain patients' diagnosis and treatment information. As to the patients' education, 72.5% of patients could not carry out self-management and 71.3% refused to follow medical advices in terms of follow-up training, 92.7% of community doctors hope to be able to discuss patients with specialists in a team way. Conclusion In order to promote the treatment and referral in community, it is necessary to strengthen the training of heart failure guidelines for community doctors, strengthen patient self-management, and establish a diagnosis and treatment platform between physicians in community and tertiary hospitals.