关键词: 社区卫生服务机构, 未分化疾病, 门诊医疗, 诊治现状, 全科医生, 上海

Abstract: Background　Community-based management of undifferentiated diseases embodies the level of professional abilities of community general practitioners（GPs） and the management quality of community healthcare institutions for the diseases. The differences of primary care needs between urban and suburban areas are becoming less，indicating that healthcare services have great development potentials in suburban areas. Objective　To perform a comparative analysis of the perceptions，outpatient management interventions，and level and associated factors of management of undifferentiated diseases，as well as required supports among GPs from community health centers（CHCs） in urban and suburban areas of Shanghai，offering guidance for promoting the development of primary care，and optimizing the distribution of primary care resources. Methods　November 2018，an online survey was conducted using a self-developed questionnaire A（CHC administrators） in administrators extracted from 244 CHCs in 16 districts（7 urban and 9 suburban） of Shanghai at a ratio of 1∶1. And another online survey was carried out using a self-developed questionnaire B（CHC GPs） among 4 047 professional title composition-matched community GPs randomly selected from these 244 CHCs（from each CHC，50% of the GPs were randomly selected according to professional title）. Data obtained from the surveys included perceptions and management of undifferentiated diseases，required help and self-rated management abilities. Urban and rural status was compared. And multivariate Logistic regression analysis was used to identify the factors associated with GPs' management abilities of undifferentiated diseases. Results　The response rates of the two surveys were 100.00%（244/244） and 96.98%（3 925/4 047），respectively. The proportions of GPs surveyed working in urban and suburban areas were 32.71%（1 284/3 925） and 67.29%（2 641/3 925），respectively. The percentages of specialists and assistant GPs in suburban CHCs were higher than those in urban CHCs. The percentages of ophthalmologists and ENT doctors in urban CHCs were higher than those of suburban CHCs. The percentages of requiring trainings for undifferentiated diseases，first management procedure of undifferentiated diseases，and requiring to be informed of designed referral rate in urban CHCs were higher than those of suburban CHCs. GPs in suburban CHCs showed higher rate of consulting less than 50 outpatients daily compared with those in urban CHCs. There were significant differences in daily outpatients volume，ability to deal with undifferentiated disease and refferal rate to higher level hospitals between GPs in urban and suburban. The factors affecting GPs' ability for managing undifferentiated diseases included title，working years，daily outpatient workload，procedure for first management of undifferentiated diseases，and rate of transferring patients with undifferentiated diseases，which were also associated with significant differences in the ability of managing the undifferentiated diseases between GPs in urban and suburban CHCs（P<0.05）. Conclusion　In Shanghai，the management of undifferentiated diseases by CHCs is relatively poor，which is more obvious in suburban areas. Community GPs have relatively insufficient perceptions of undifferentiated diseases，as well as insufficient ability for managing these diseases. Relatively speaking，compared with those working in urban CHCs，GPs in suburban CHCs have higher rates of owning less professional qualifications and less sufficient practice，requiring the training of standardized procedure for managing these diseases，and transferring undifferentiated disease patients to higher level hospitals. In view of this，relevant guidelines should be improved，and first management procedure development as well as trainings and clinical management of undifferentiated diseases should be strengthened.

Key words: Community health service instituions, Undifferentiated diseases, Ambulatory care, Current status of diagnosis and treatment, General practitioners, Shanghai