关键词: 社区卫生服务；医生, 初级保健；卒中；二级预防；教育, 医学

Abstract: Background　For stroke patients，secondary prevention is of great significance in preventing the incidence of vascular complications and recurrence of stroke.Community physicians play a major role in the prevention and treatment of stroke.Objective　To evaluate community physicians' pre-training and post-training awareness levels of the controllable risk factors in secondary prevention of stroke，and based on this，to assess the training effect.Methods　By use of simple random sampling，we selected 50 community physicians whose scope of practice is internal medicine or general practice from 12 community health centers in Mentougou District of Beijing from May 2017 to May 2018.They received a training about controllable risk factors in secondary prevention of stroke，including standardized secondary prevention and management of abnormal blood pressure，blood glucose and blood lipids，and atrial fibrillation，and the management of antiplatelet aggregation therapy.Before and after the training，the participants received an assessment of the awareness level of the related data，respectively，and the pre- and post-training qualified rates in each aspect were compared to evaluate the training effect.In terms of the aspects of knowledge that the participants still mastered unsatisfactorily after training（qualified rate <90.0%），Pareto analysis was used to explore the associated factors. Results　Before training，the percentage of participants with a qualified mastery of the knowledge about blood pressure management for stroke was 80.0%，but the percentages with a qualified mastery of the knowledge about blood glucose，blood lipids，atrial fibrillation，and antiplatelet aggregation therapy were all less than 80.0%.After training，the percentages of participants with a qualified mastery of the knowledge of the 5 aspects increased significantly compared with pre-training（P<0.05）.Except for the aspect of management of atrial fibrillation 〔pass rate was 70.0%（35/50）〕，the percentages of participants who had a qualified mastery of the knowledge of other 4 aspects reached the desired requirements 〔pass rate were 100.0%（50/50），92.0%（46/50），90.0%（45/50），96.0%（48/50）〕.Pareto analysis found that，the awareness level of anticoagulant drugs（40.0%，20/50），mastery of the indications of anticoagulation in atrial fibrillation（28.0%，14/50） and bleeding risk assessment of anticoagulant treatment for atrial fibrillation（18.0%，9/50） were factors associated with the unsatisfactory training effect of atrial fibrillation management.Conclusion　In general，the awareness level of controllable risk factors in secondary prevention of stroke is inadequate in community physicians.To be specific，they have a good mastery of the knowledge of blood pressure management，but have an unsatisfactory mastery of the knowledge of atrial fibrillation management.Corresponding standardized training can improve their awareness levels of such knowledge.

Key words: Community health services；Physicians, primary care；Stroke；Secondary prevention；Education, medical