广西农村执业医师多重慢病诊疗认知状况和培训需求调查

彭厚瑄; 申颖; 赵璨; 韦耿贵; 奚谦; 陈培萌

doi:10.16766/j.cnki.issn.1674-4152.004346

广西农村执业医师多重慢病诊疗认知状况和培训需求调查

doi: 10.16766/j.cnki.issn.1674-4152.004346

彭厚瑄¹,
申颖^2, ,,
赵璨¹,
韦耿贵³,
奚谦⁴,
陈培萌⁵

1.
广西医科大学第一附属医院全科医学科，广西南宁 530021
2.
广西医科大学全科医学院，广西南宁 530021
3.
南宁市马山县人民医院，广西南宁 530600
4.
南宁市江南区延安镇卫生院，广西南宁 530229
5.
梧州市岑溪市糯垌镇中心卫生院，广西梧州 543214

基金项目:

广西教育科学“十四五”规划2023年度课题 2023B132

详细信息

通讯作者:
申颖，E-mail：1344111999@qq.com

中图分类号: R197.62 R192.3
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2025-04-22
- 网络出版日期: 2026-04-01

A study on knowledge of multimorbidity diagnosis and treatment and need for relevant trainings of rural licensed physicians in Guangxi

1.
Department of General Practice, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China

摘要

摘要: 目的本研究旨在了解广西农村执业医师对多重慢病诊疗的认知现状和培训需求，为有效开展相关教育培训提供有益参考。方法 2024年2—8月，采用分层抽样法和整群抽样法抽取广西2家县级综合医院和32家乡镇卫生院为样本机构，通过问卷星向样本机构全体执业医师发放自设问卷，以县级医院执业医师为非基层医疗机构组，乡镇卫生院执业医师为基层医疗机构组。采用χ²检验等统计学方法分析农村执业医师对多重慢病诊疗的认知现况和培训需求。结果发放问卷1 200份，最终回收994份，有效回收率为82.8%。绝大多数农村执业医师在多重慢病筛查、评估、管理、转诊及临床指南等题项中选择“一般了解”或“较少了解”或“完全不了解”，但较少人选择“了解”或“非常了解”；基层医疗机构组对某些题项的认知状况优于非基层医疗机构组(P < 0.05)。农村执业医师对多重慢病相关培训需求强烈，倾向于线上线下结合、理论与实践并重、中低频次的培训模式和频率。结论广西农村执业医师自感多重慢病诊疗的认知水平有限，尤其缺乏多重慢病筛查、评估、管理及临床指南等知识和技能；建议采取线上线下混合式、理论结合实践的培训模式加强相关培训，切实提高农村执业医师多重慢病的防治能力。
- 多重慢病 /
- 农村地区 /
- 认知状况 /
- 培训需求 /
- 农村执业医师
Abstract: Objective This study aims to investigate knowledge of multimorbidity diagnosis and treatment and the need for relevant training of rural licensed physicians in Guangxi, and to offer guidance on effective implementation of relevant education and training. Methods From February to Aug 2024, 2 county general hospitals and 32 township health centers in Guangxi were sampled using a combination of stratified and cluster sampling, and a self-designed questionnaire was sent via the national online platform "Wenjuanxing" to all licensed physicians working in all the above organizations. The licensed physicians working in the township health centers were assigned to the group of primary health care organization, and those in the county hospitals to the group of non-primary health care organization. Chi-square test was employed to analyze knowledge of multimorbidity diagnosis and treatment, and the need for relevant training of rural licensed physicians. Results A total of 1 200 questionnaires were sent out, and eventually 994 verified copies were back, accounting for 82.8%. The majority of rural licensed physicians chose "know some" or " know less" or "never know" on items related to screening, assessment, management, referral, and clinical guidelines, and only a few picked up "know" or "know well". The group of primary health care organization demonstrated better knowledge on some items than the group of non-primary health care organization (P < 0.05). Rural licensed physicians showed an urge for training in multimorbidity and preferred it to be carried out in a way characterized by a mixture of online and offline patterns, a combination of theory and practice, and low to middle frequency. Conclusion The rural licensed physicians in Guangxi feel that their knowledge about multimorbidity diagnosis and treatment is limited, especially regarding screening, assessment, management, and clinical guidelines. It is suggested to adopt the model with a mixture of online and offline patterns and inclusion of theory and practice to enhance relevant training, to effectively promote competence of rural licensed physicians on multimorbidity diagnosis and treatment.
- Multimorbidity /
- Rural areas /
- Level of knowledge /
- Need for trainings /
- Rural licensed physicians

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表 1 广西994名农村执业医师基本人口学信息[人(%)]

Table 1. Basic demographic characteristics of 994 rural practicing physicians in Guangxi[people(%)]

项目	人数	基层医疗机构(n=539)	非基层医疗机构(n=455)	χ²值	P值
性别				11.597	0.001
女性	541	320(59.37)	221(48.57)^a
男性	453	219(40.63)	234(51.43)^a
学历				342.516	< 0.001
中专及以下	19	14(2.60)	5(1.10)
高中	4	3(0.56)	1(0.22)
大专	516	420(77.92)	96(21.10)^a
本科及以上	455	102(18.92)	353(77.58)^a
职称				24.052	< 0.001
住院医师	741	422(78.29)	319(70.11)^a
主治医师	184	97(18.00)	87(19.12)^a
副主任医师	59	20(3.71)	39(8.57)^a
主任医师	10	0	10(2.20)^a
执业注册范围				222.117	< 0.001
全科医学	428	348(64.56)	80(17.58)^a
非全科医学	566	191(35.44)	375(82.42)^a
工作年限				133.873	< 0.001
5年及以下	276	74(13.73)	202(44.40)^a
6~10年	400	273(50.65)	127(27.91)^a
11~15年	238	158(29.31)	80(17.58)^a
15年以上	80	34(6.31)	46(10.11)^a
工作部门				79.480	< 0.001
住院部	522	237(43.97)	285(62.64)^a
住院部+急诊科	15	14(2.60)	1(0.22)^a
急诊科	37	13(2.41)	24(5.27)^a
门诊	160	90(16.70)	70(15.38)
门诊+住院部	161	99(18.37)	62(13.63)^a
门诊+住院部+急诊科	87	78(14.47)	9(1.98)^a
门诊+急诊科	12	8(1.48)	4(0.88)
注：与同类别基层医疗机构比较，^aP < 0.05。

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表 2 广西994名农村执业医师对多重慢病诊疗的认知状况[人(%)]

Table 2. Knowledge on diagnosis and treatment of multimorbidity among 994 rural licensed physicians of Guangxi[people(%)]

题项	选项	基层医疗机构	非基层医疗机构	总计	χ²值	P值
Q1.是否了解多重慢病的定义？	A非常了解	39(7.24)	38(8.35)	77(7.75)	1.062	0.900
	B了解	218(40.45)	176(38.68)	394(39.64)
	C一般了解	191(35.44)	160(35.16)	351(35.31)
	D较少了解	89(16.51)	78(17.14)	167(16.80)
	E完全不了解	2(0.37)	3(0.66)	5(0.50)
Q2.是否了解与多重慢病发生发展相关的衰老和炎症机制？	A非常了解	28(5.19)	20(4.40)	48(4.83)	1.399	0.844
	B了解	140(25.97)	121(26.59)	261(26.26)
	C一般了解	207(38.40)	168(36.92)	375(37.73)
	D较少了解	136(25.23)	126(27.69)	262(26.36)
	E完全不了解	28(5.19)	20(4.40)	48(4.83)
Q3.是否了解与多重慢病发生发展相关的社会经济、社会心理及行为的决定因素？	A非常了解	24(4.45)	24(5.27)	48(4.83)	0.880	0.927
	B了解	159(29.50)	128(28.13)	287(28.87)
	C一般了解	210(38.96)	172(37.80)	382(38.43)
	D较少了解	127(23.56)	113(24.84)	240(24.14)
	E完全不了解	19(3.53)	18(3.96)	37(3.72)
Q4.是否了解促进多重慢病发生发展相关的药物？	A非常了解	25(4.64)	19(4.18)	44(4.43)	1.204	0.877
	B了解	145(26.90)	110(24.18)	255(25.65)
	C一般了解	200(37.11)	177(38.90)	377(37.93)
	D较少了解	147(27.27)	129(28.35)	276(27.77)
	E完全不了解	22(4.08)	20(4.40)	42(4.23)
Q5.是否了解老年综合征(痴呆、抑郁、衰弱、营养不良)的筛查和诊疗方法？	A非常了解	20(3.71)	19(4.18)	39(3.92)	5.236	0.264
	B了解	145(26.90)	103(22.64)	248(24.95)
	C一般了解	203(37.66)	160(35.16)	363(36.52)
	D较少了解	141(26.16)	141(30.99)	282(28.37)
	E完全不了解	30(5.57)	32(7.03)	62(6.24)
Q6.是否了解老年综合评估(CGA)的内容和方法？	A非常了解	20(3.71)	17(3.74)	37(3.72)	9.503	0.050
	B了解	121(22.45)	85(18.68)	206(20.72)
	C一般了解	174(32.28)	122(26.81)	296(29.78)
	D较少了解	155(28.76)	151(33.19)	306(30.78)
	E完全不了解	69(12.80)	80(17.58)	149(14.99)
Q7.是否了解优先识别可从特殊共病管理流程中获益的老年人的方法和措施？	A非常了解	21(3.90)	18(3.96)	39(3.92)	6.945	0.139
	B了解	123(22.82)	85(18.68)	208(20.93)
	C一般了解	185(34.32)	142(31.21)	327(32.90)
	D较少了解	155(28.76)	145(31.87)	300(30.18)
	E完全不了解	55(10.20)	65(14.29)	120(12.07)
Q8.是否了解确定和调整多重慢病管理目标的原则？	A非常了解	19(3.53)	18(3.96)	37(3.72)	11.103	0.025
	B了解	137(25.42)	95(20.88)	232(23.34)
	C一般了解	200(37.11)	149(32.75)	349(35.11)
	D较少了解	141(26.16)	134(29.45)	275(27.67)
	E完全不了解	42(7.79)	59(12.97)^a	101(10.16)
Q9.是否了解多重慢病管理的流程？	A非常了解	18(3.34)	21(4.62)	39(3.92)	7.972	0.093
	B了解	121(22.45)	84(18.46)	205(20.62)
	C一般了解	188(34.88)	140(30.77)	328(33.00)
	D较少了解	157(29.13)	146(32.09)	303(30.48)
	E完全不了解	55(10.20)	64(14.07)	119(11.97)
Q10.是否了解世界卫生组织关于活力老年人、内在能力下降或衰弱老年人、失能且不可逆转老年人的区分指标及方法？	A非常了解	18(3.34)	18(3.96)	36(3.62)	16.009	0.003
	B了解	109(20.22)	74(16.26)	183(18.41)
	C一般了解	181(33.58)	120(26.37)^a	301(30.28)
	D较少了解	160(29.68)	148(32.53)	308(30.99)
	E完全不了解	71(13.17)	95(20.88)^a	166(16.70)
Q11.是否了解活力老年人、内在能力下降或衰弱老年人、失能且不可逆转老年人的管理目标和干预措施？	A非常了解	18(3.34)	16(3.52)	34(3.42)	16.455	0.002
	B了解	119(22.08)	91(20.00)	210(21.13)
	C一般了解	197(36.55)	124(27.25)^a	321(32.29)
	D较少了解	154(28.57)	154(33.85)	308(30.99)
	E完全不了解	51(9.46)	70(15.38)^a	121(12.17)
Q12.多重慢病管理决策中，患者的自我意愿、患者参与及自我管理的重要性如何？	A非常重要	211(39.15)	175(38.46)	386(38.83)	5.138	0.273
	B重要	204(37.85)	182(40.00)	386(38.83)
	C一般	94(17.44)	77(16.92)	171(17.20)
	D不重要	19(3.53)	7(1.54)	26(2.62)
	E完全不重要	11(2.04)	14(3.08)	25(2.52)
Q13.是否了解多重用药的调整方法？	A非常了解	24(4.45)	20(4.40)	44(4.43)	10.584	0.032
	B了解	159(29.50)	113(24.84)	272(27.36)
	C一般了解	197(36.55)	162(35.60)	359(36.12)
	D较少了解	135(25.05)	118(25.93)	253(25.45)
	E完全不了解	24(4.45)	42(9.23)^a	66(6.64)
Q14.是否了解评价多重慢病结局的常用指标？	A非常了解	23(4.27)	17(3.74)	40(4.02)	16.793	0.002
	B了解	151(28.01)	103(22.64)	254(25.55)
	C一般了解	186(34.51)	146(32.09)	332(33.40)
	D较少了解	138(25.60)	119(26.15)	257(25.86)
	E完全不了解	41(7.61)	70(15.38)^a	111(11.17)
Q15.是否了解多重慢病患者的转诊指征？	A非常了解	30(5.57)	28(6.15)	58(5.84)	42.477	< 0.001
	B了解	197(36.55)	118(25.93)^a	315(31.69)
	C一般了解	203(37.66)	140(30.77)^a	343(34.51)
	D较少了解	92(17.07)	123(27.03)^a	215(21.63)
	E完全不了解	17(3.15)	46(10.11)^a	63(6.34)
Q16.是否了解多重慢病的相关临床诊疗指南？	A非常了解	18(3.34)	21(4.62)	39(3.92)	30.143	< 0.001
	B了解	158(29.31)	99(21.76)^a	257(25.86)
	C一般了解	216(40.07)	143(31.43)^a	359(36.12)
	D较少了解	118(21.89)	140(30.77)^a	258(25.96)
	E完全不了解	29(5.38)	52(11.43)^a	81(8.15)
注：与基础医疗机构比较，^aP < 0.05。

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表 3 广西农村执业医师对多重慢病培训的意愿、形式及频率需求

Table 3. Intension, preferred mode and frequency of multimorbidity trainings for rural licensed physicians in Guangxi

题项	选项	人数(%)
Q17.多重慢病相关的教育及培训(单选)	非常需要	558(56.14)
	需要	374(37.63)
	无所谓	28(2.82)
	不需要	17(1.71)
	完全不需要	17(1.71)
Q18.合适的培训频率(单选)	每周1~2次	94(9.46)
	每月1~2次	387(38.93)
	每季度1~2次	296(29.78)
	每半年1~2次	134(13.48)
	每年1~2次	83(8.35)
Q19.倾向的教育培训形式(多选)	线上培训	745(74.95)
	线下培训	704(70.82)
	含技能展示的培训	837(84.21)
	理论授课	681(68.51)
Q20.需要的培训内容(多选)	多重慢病的概念	715(71.93)
	多重慢病的流行病学特征和疾病负担	742(74.65)
	多重慢病的发生发展机制	672(67.61)
	多重慢病患者筛查和综合评估方法	776(78.07)
	多重慢病的诊断和分类	740(74.45)
	多重慢病的管理措施	716(72.03)
	多重慢病的结局测量指标和测量方法	630(63.38)
	多重慢病患者转诊指征	628(63.18)
	多重慢病的临床指南	689(69.32)

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