浙江省全科医生对未分化疾病诊治的观点研究

娄铮; 刘颖; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.003394

浙江省全科医生对未分化疾病诊治的观点研究

doi: 10.16766/j.cnki.issn.1674-4152.003394

娄铮^{1, 2},
刘颖²,
任菁菁^2, ,

1.
杭州医学院附属天台医院全科医学科，浙江台州 317200
2.
浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金项目 72274169

浙江省教育厅一般科研项目 Y202146068

杭州医学院科技创新引导基金项目 CX2022021

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R499
计量
- 文章访问数: 46
- HTML全文浏览量: 20
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-18
- 网络出版日期: 2024-03-27

A study of the opinions of general practitioners in Zhejiang Province on the diagnosis and treatment of medically unspecified disease

LOU Zheng^{1, 2},
LIU Ying²,
REN Jingjing^{2
, ,}

1.
Department of General Practice, Affiliated Tiantai Hospital, Hangzhou Medical College, Taizhou, Zhejiang 317200, China

摘要

摘要: 目的了解全科医生对未分化疾病(MUD)诊治现状的观点，为MUD的综合管理提供建议。方法于2019年6—8月在浙江省11个地级市采用分层整群抽样的方式抽取全科医生425名，自行设计调查问卷对全科医生进行调查，问卷内容包括全科医师的基本信息和全科医师对MUD诊治的观点，采用“李克特量表”评分法进行评分，并对问卷结果进行统计分析。结果共发放问卷425份，回收有效问卷325份。男性127人(39.1%)，女性198人(60.9%)，年龄为(38.41±7.74)岁。调查发现54.1%的全科医生在接诊MUD患者时感到有压力，41.6%不知该如何处置MUD，绝大部分全科医生(72.0%)认为值得尝试去帮助这些患者，70.5%的全科医生认为MUD在诊断上具有挑战性，而68.3%的全科医生则认同MUD在治疗上具有挑战性。综合医院工龄越高的男性全科医生，接诊MUD的意愿越高。全科医生普遍认为MUD给患者带来巨大压力。年龄、工龄、职称、学历、工作所在地、医院级别对全科医生诊治MUD患者的能力均存在影响。结论目前全科医生对MUD诊治信心不足，需建设以综合医院全科医学科为主导、多学科及社区医院联合的MUD诊疗中心，制定规范化MUD诊疗处置流程，实施早期培训计划，培养全科医生的全科思维，提升沟通、诊疗能力，建立和谐的医患关系及医患共同决策个体化方案。
- 未分化疾病 /
- 全科医生 /
- 诊疗中心 /
- 共同决策
Abstract: Objective To understand the perspectives of general practitioners regarding the diagnosis and treatment of medically unspecified disease (MUD). Methods From June to August 2019, a total of 425 general practitioners from 11 prefecture level cities of Zhejiang Province were selected using stratified cluster sampling. These practitioners were investigated using a self-designed questionnaire that covered their basic information and perspectives on the diagnosis and treatment of MUD. The questionnaire utilized the "Likert Scale" scoring method for evaluation and subsequent statistical analysis. Results A total of 425 questionnaires were distributed, with 325 recovered and deemed valid. Among the respondents, there were 127 males (39.1%) and 198 females (60.9%), with an average age of (38.41±7.74) years. The survey found that 54.1% of general practitioners expressed pressure when treating MUD patients, while 41.6% expressed uncertainty in handing MUD cases. However, a significant majority (72.0%) of general practitioners believed it was worthwhile to assist these patients. Additionally, 70.5% of general practitioners considered MUD challenging to diagnosis, and 68.3% found MUD treatment to be challenging. Notably, male general practitioners in general hospitals demonstrated a higher willingness to treat MUD, which correlated with their years of experience. Overall, general practitioners acknowledged the significant pressure posed by MUD patients. Furthermore, age, length of service, professional title, educational background, workplace, and hospital level all affected doctors ' approach to the diagnosis and treatment of MUD. Conclusion Currently, general practitioners lack confidence in the diagnosis and treatment of MUD. To address this issue, it is necessary to establish a MUD diagnosis and treatment center under the leadership of the general medical department in a general hospital. This center should collaborate with multidisciplinary teams and community hospitals to develop a standardized MUD diagnosis and treatment process. Additionally, implementing an early training plan is necessary to foster general practitioners ' general practice thinking, improve their communication skills, and enhance their diagnosis and treatment ability. It is important to establish a harmonious doctor-patient relationship and promote individualized joint decision-making between doctors and patients. Finally, comprehensive management of MUD should be supported by providing recommendations and guidance.
- Medically unspecified disease /
- General practitioners /
- Diagnosis and treatment centers /
- Joint decision-making

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表 1 325名被调查者基本情况

Table 1. Basic information of 325 respondents

项目	类别	人数	构成比(%)
性别	男性	127	39.1
	女性	198	60.9
年龄(岁)	≤40	197	60.6
	>40	128	39.4
职称	主任/副主任医师	87	26.8
	中级	119	36.6
	初级	119	36.6
学历	研究生	23	7.1
	本科	258	79.4
	大专及以下	44	13.5
工作年限(年)	≤10	110	33.8
	>10	215	66.2
工作所在地	浙东	123	37.9
	浙南	71	21.8
	浙中	37	11.4
	浙西	28	8.6
	浙北	66	20.3
所在单位	医院	71	21.8
	社区	254	78.2

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表 2 全科医生对MUD患者的诊治观点[人(%)]

Table 2. General practitioners ' views on the diagnosis and treatment of MUD patients [person (%)]

诊治观点	完全同意	部分同意	不确定	部分不同意	完全不同意
我喜欢接诊MUD患者	63(19.4)	89(27.4)	103(31.7)	54(16.6)	16(4.9)
我觉得接诊MUD患者占用了大量时间，这些时间我可以处理更多其他患者	28(8.6)	78(24.0)	90(27.7)	74(22.8)	55(16.9)
我发现接诊MUD患者常常带给我很大的压力	43(13.2)	133(40.9)	75(23.1)	52(16.0)	22(6.8)
我觉得不值得为MUD患者尝试做太多事情	4(1.2)	32(9.8)	55(16.9)	86(26.5)	148(45.5)
我发现MUD患者给我带来诊断上有趣的挑战	90(27.7)	139(42.8)	68(20.9)	22(6.8)	6(1.8)
我发现MUD患者给我带来治疗上有趣的挑战	89(27.4)	133(40.9)	74(22.8)	24(7.4)	5(1.5)
我常常不知道如何帮助MUD患者	24(7.4)	111(34.2)	81(24.9)	80(24.6)	29(8.9)

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表 3 不同人口学特征全科医生对MUD诊治的观点比较分析[M(P₂₅, P₇₅), 分]

Table 3. Comparative analysis of the views of general practitioners with different demographic characteristics on the diagnosis and treatment of MUD [M(P₂₅, P₇₅), points]

人口学特征	我喜欢接诊MUD患者	我觉得接诊MUD患者占用了大量时间，这些时间我可以处理更多其他患者	我发现接诊MUD患者常常带给我很大的压力	我觉得不值得为MUD患者尝试做太多事情	我发现MUD患者给我带来诊断上有趣的挑战	我发现MUD患者给我带来治疗上有趣的挑战	我常常不知道如何帮助MUD患者
性别
男性	4(3，5)	3(2，4)	3(2，4)	2(1，3)	4(3，5)	4(3，5)	3(2，4)
女性	3(3，4)	3(2，4)	4(3，4)	1.5(1，2)	4(3，4)	4(3，4.25)	3(2，4)
Z值	-2.243	-1.210	-1.325	-2.341	-0.658	-0.151	-3.449
P值	0.025	0.226	0.185	0.019	0.511	0.880	0.001
年龄(岁)
≤40	3(3，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	4(3，4)
>40	4(3，4.75)	3(2，4)	4(2，4)	2(1，3)	4(3，5)	4(3，5)	2(2，2)
Z值	-1.389	-2.012	-0.654	-0.927	-1.199	-1.575	-15.069
P值	0.165	0.044	0.513	0.354	0.230	0.115	＜0.001
职称
高级	4(3，5)	3(2，4)	4(2，4)	1(1，2)	4(4，5)	4(4，5)	2(2，3)
中级	3(3，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	3(2.5，4)
初级	3(3，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	4(3，4)
χ²值	5.112	1.236	2.654	5.357	9.175	6.027	106.127
P值	0.078	0.539	0.265	0.069	0.010	0.049	＜0.001
学历
研究生	4(3，5)	3(2，3)	3(2，4)	1(1，2)	4(4，5)	4(4，5)	4(3，4)
本科	3(3，4)	3(2，4)	4(3，4)	2(1，3)	4(3，5)	4(3，5)	3(2，4)
大专及以下	3(2，4)	3(2，3)	4(3，4)	2(1，3)	4(3，4.5)	4(3，5)	2(1，3)
χ²值	4.278	1.159	3.360	4.238	4.078	2.471	21.841
P值	0.118	0.560	0.186	0.120	0.130	0.291	＜0.001
工作年限(年)
≤10	3(2，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	4(4，4)
>10	3(3，4)	3(2，4)	4(2，4)	2(1，3)	4(3，5)	4(3，5)	2(2，3)
Z值	-2.186	-1.134	-1.052	-0.343	-1.174	-1.077	-13.420
P值	0.029	0.257	0.293	0.732	0.241	0.281	＜0.001
工作所在地
浙东	3(2，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	3(2，4)
浙南	4(3，4.5)	3(1.5，3.5)	4(3，4)	2(1，3)	4(3，5)	4(3，5)	3(2，4)
浙中	4(3，4)	3(2，4)	4(3，4)	1(1，2)	4(4，5)	4(4，5)	3(3，4)
浙西	4(3，4)	3(2，3)	3(3，4)	2(1，3)	4(3，4.5)	4(3，4.5)	2.5(2，5)
浙北	3(3，4)	3(2，4)	3(2，4)	2(1，3)	4(3，5)	4(3，4)	3(2，4)
χ²值	9.135	5.874	6.226	10.889	4.342	3.367	12.998
P值	0.058	0.209	0.183	0.028	0.362	0.498	0.011
所在单位
医院	4(3，5)	3(2，4)	4(2，4)	1(1，2)	4(4，5)	4(4，5)	4(2，4)
社区	3(3，4)	3(2，4)	4(3，4)	2(1，3)	4(3，4)	4(3，4)	3(2，4)
Z值	-2.947	-0.292	-1.018	-3.568	-4.167	-4.434	-3.408
P值	0.003	0.770	0.309	＜0.001	＜0.001	＜0.001	0.001

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