全科医生临床实践中知识型临床问题的处理现状研究

doi:10.12114/j.issn.1007-9572.2021.00.047

中国全科医学 ›› 2021, Vol. 24 ›› Issue (13): 1602-1606.DOI: 10.12114/j.issn.1007-9572.2021.00.047

所属专题：社区卫生服务最新研究合集

全科医生临床实践中知识型临床问题的处理现状研究

李源杰1，徐娜1，沙悦1，苏巧俐2，朱卫国1，3*，曾学军1

1.100730北京市，中国医学科学院北京协和医院全科医学科　2.610041四川省成都市，四川大学华西医院全科医学科　3.100730北京市，中国医学科学院北京协和医院信息中心
*通信作者：朱卫国，副教授；E-mail：zhuwg@pumch.cn

出版日期:2021-05-05 发布日期:2021-05-05
基金资助:
美国中华医学基金会公开竞标项目（CMB-OC）（16-258）；首都卫生发展科研专项项目（首发 2018-1-4012）

Solving of Knowledge-based Clinical Questions by General Practitioners in Daily Practice　

LI Yuanjie1，XU Na1，SHA Yue1，SU Qiaoli2，ZHU Weiguo1，3*，ZENG Xuejun1

1.Department of Primary Care and Family Medicine，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College，Beijing 100730，China
2.Department of General Practice，West China Hospital，Sichuan University，Chengdu 610041，China
3.Division of Information Management，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College，Beijing 100730，China
*Corresponding author：ZHU Weiguo，Associate professor；E-mail：zhuwg@pumch.cn

Published:2021-05-05 Online:2021-05-05

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摘要/Abstract

摘要： 背景　当前国内大力推进分级诊疗，难点之一是提高全科医生的首诊能力，研究全科医生在日常临床实践中需解决的问题，有助于提供针对性的辅助，提高其岗位胜任力。目的　调查全科医生临床实践中遇到知识型临床问题的频率及处理现状。方法　于2020年2—4月，采用便利抽样法对参加全科医师协会活动的300名医生进行线上问卷调查，了解其遇到知识型临床问题的频率、种类和处理方式，并采用多因素Logistic回归分析影响问题查询率和解答率的因素。结果　回收有效问卷297份（99.0%），其中女性医生、中高级职称医生、工作10年以上者分别占69.7%（207/297）、75.2%（221/294）和48.5%（144/297）。117例（39.4%）全科医生经常或每天遇到无法现场解答的临床问题，约每接诊4.6名患者遇到1个问题；最常见的问题涉及药品使用、病理生理、鉴别诊断和疾病诊断。仅50.7%（150/296）全科医生会查询大部分（>60%）问题；仅12.9%（38/296）能找到>80%的问题答案，主要查询途径是教科书、通用搜索网站（如百度）、咨询他人；91例（30.6%）报告工作场所提供专业信息检索工具。多因素Logistic回归分析结果显示单元接诊量较少、遇到问题频率较低和习惯检索专业信息的医生更可能查找问题（P<0.05）；遇到问题频率较低和积极查询问题者找到正确答案的比例更高（P<0.05）。结论　全科医生在临床实践中遇到知识型临床问题而未得到有效解答的现象常见，主要包括诊断和治疗方面的问题。缺乏时间和高效率的问题检索习惯是妨碍临床问题解答的主要影响因素。

关键词: 全科医生, 临床问题, 信息查询行为, 临床决策

Abstract: Background　A major difficulty during the promotion of the three-tiered healthcare delivery system in China is to improve the level of first-contact care provided by general practitioners（GPs）. Studying GPs' solving of problems encountered in daily clinical practice is valuable to provide targeted assistance to improve GPs' competency. Objective　To investigate the frequency of knowledge-based clinical questions encountered by Chinese GPs and their management methods.Methods　From February to April 2020，an online questionnaire survey was conducted with a convenience sample of 300 GPs attending the activities carried out by local GP associations. Details of frequency and types of knowledge-based clinical questions encountered by GPs and their management were investigated. Factors associated with the rate of seeking answers to questions，and the rate of giving an answer to the questions were analyzed by multivariate logistic regression. Results　A total of 297 cases（99.0%） who responded to the survey were included for analysis. Among them，women，those with an intermediate or senior professional title，and those with a working experience of at least 10 years accounted for 69.7%（207/297），75.2%（221/294），and 48.5%（144/297），respectively. 117（39.4%） reported that they often encountered clinical questions that they could not answer on-site，with a frequency of 1 question per 4.6 patients on average，commonly involving drug use，pathophysiology，differential diagnosis and diagnosis. 50.7%（150/296） of the respondents reported that they tried to seek answers to most（more than 60%） of the questions，mainly by consulting textbooks，searching websites using an engine（for example，Baidu），and consulting others，but only 12.9%（38/296） finally succeeded in retrieving satisfactory answers to over 80% of those questions. 91（30.6%） reported that there was information retrieval condition in the workplace. Multivariate Logistic regression analysis suggested that less visits per working unit，lower frequency of encountering questions，and being accustomed to searching for medical information（P<0.05）were associated with higher possibility of seeking answers（P<0.05）. Lower frequency of encountering questions，and actively seeking answers were associated with higher possibility of finding a correct answer（P<0.05）. Conclusion　It is common that GPs fail to give satisfactory answers to knowledge-based clinical questions（including diagnosis and treatment） related to patient care，which may be caused by GPs' lack of sufficient time and a habit of seeking answers highly efficiently.

Key words: General practitioner, Clinical questions, Information Seeking Behavior, Decision Making

李源杰,徐娜,沙悦,等. 全科医生临床实践中知识型临床问题的处理现状研究[J]. 中国全科医学, 2021, 24(13): 1602-1606. DOI: 10.12114/j.issn.1007-9572.2021.00.047.
LI Yuanjie,XU Na,SHA Yue, et al. Solving of Knowledge-based Clinical Questions by General Practitioners in Daily Practice　[J]. Chinese General Practice, 2021, 24(13): 1602-1606. DOI: 10.12114/j.issn.1007-9572.2021.00.047.

参考文献

［1］ARORA S，THORNTON K，DUHIGG D．Demonopolizing medical knowledge［J］．Acad Med，2014，89（1）：30-32．
［2］DEL FIOL G，WORKMAN T E，GORMAN P N．Clinical questions raised by clinicians at the point of care：a systematic review［J］．JAMA Intern Med，2014，174（5）：710-718．
［3］DEL FIOL G，WEBER A I，BRUNKER C P，et al．Clinical questions raised by providers in the care of older adults：a prospective observational study［J］．BMJ Open，2014，4（7）：e005315．
［4］PLUYE P，GRAD R M，DUNIKOWSKI L G，et al．Impact of clinical information-retrieval technology on physicians：a literature review of quantitative，qualitative and mixed methods studies［J］．Int J Med Inform，2005，74（9）：745-768．
［5］MAGGIO L A，AAKRE C A，DEL FIOL G，et al．Impact of clinicians' use of electronic knowledge resources on clinical and learning outcomes：systematic review and meta-analysis［J］．J Med Internet Res，2019，25，21（7）：e13315．
［6］ZHAO Y，CHEN R，WANG B，et al．General practice on-the-job training in Chinese urban community：a qualitative study on needs and challenges［J］．PLoS One，2014，9（4）：e94301．
［7］BRASSIL E，GUNN B，SHENOY A M，et al．Unanswered clinical questions：a survey of specialists and primary care providers［J］．J Med Libr Assoc，2017，105（1）：4-11．DOI：10.5195/jmla.2017.101.
［8］ELLSWORTH M A，HOMAN J M，CIMINO J J，et al．Point-of-care knowledge-based resource needs of clinicians［J］．Applied Clinical Informatics，2015，6（2）：305-317．
［9］WU D，LAM T P，LAM K F，et al．Public views towards community health and hospital-based outpatient services and their utilisation in Zhejiang，China：a mixed methods study［J］．BMJ Open，2017，7（11）：e017611．
［10］武宁，程明羕，闫丽娜，等．中国全科医生培养发展报告（2018）［J］．中国全科医学，2018，21（10）：1135-1142．DOI：10.3969/j.issn.1007-9572.2018.10.001.
WU N，CHENG M Y，YAN L N，et al．Training development report of GPs（2018）［J］．Chinese General Practice，2018，21（10）：1135-1142．DOI：10.3969/j.issn.1007-9572.2018.10.001.
［11］SCHAAFSMA F，HULSHOF C，DE BOER A，et al．Occupational physicians：what are their questions in daily practice? An observation study［J］．Occup Med（Lond），2006，56（3）：191-198．DOI：10.1093/occmed/kqj030.
［12］高青，朱旬，高雅，等．基于莱斯特评估套件的全科医生技能培训效果评价研究［J］．中国全科医学，2017，20（16）：1987-1993．DOI：10.3969/j.issn.1007-9572.2017.16.017.
GAO Q，ZHU X，GAO Y，et al．Evaluation of the effect of skills training for general practitioners by Leicester assessment package［J］．Chinese General Practice，2017，20（16）：1987-1993．DOI：10.3969/j.issn.1007-9572.2017.16.017.

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全科医生临床实践中知识型临床问题的处理现状研究

Solving of Knowledge-based Clinical Questions by General Practitioners in Daily Practice

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