Abstract:

Background　General practitioners（GPs） may be the most appropriate provider of clinical preventive services，and outpatient consultations may be the most suitable delivery way. However，the level of clinical preventive services provided by GPs during outpatient consultations is unknown in China. Objective　To examine the level of clinical preventive services provided by GPs during consultations in outpatient primary care settings in China. Methods　This study was implemented during July 2018 to January 2019. By using a three-stage sampling，18 GPs from 8 community health centers in Guangdong Province，and 649 patients managed by them were selected. The data of outpatient consultations were obtained with direct observation and audio recording，in which the information of preventive interventions was described structurally and quantitatively using the internationally used Davis Observation Code. Results　Of the 649 cases，186（28.7%） received at least one kind of clinical preventive service. Only 3 GPs provided clinical preventive services in more than 50% of their outpatient consultations.Patient nutrition counseling，disease screening and vaccination counseling and sleep counseling with recommended tips offered by GPs，accounted for 13.4%，9.4%，5.6% of all consultations，respectively. And the average consultation duration for the above-mentioned services was（17.61±18.37），（15.77±15.62） and （13.53±18.59） seconds，respectively，among the service recipients. Conclusion　The level of clinical preventive services provided by Chinese GPs during outpatient consultations is still very low，which may considerably fall behind that in foreign countries.

Key words: General practitioner, Clinical preventive services, Inquiring, Observational studies

摘要： 背景　全科医生是提供临床预防服务的最佳人选，门诊问诊是其提供临床预防服务最适合的时机，但目前我国全科医生在门诊问诊过程中提供临床预防服务的实际水平如何是未知的。目的　测量我国基层全科医生门诊问诊过程中临床预防服务项目的提供水平。方法　2018年7月—2019年1月，采用三阶段抽样策略，选取广东省8家社区卫生服务中心的18名全科医生的649名患者的门诊问诊进行门诊直接观察和录音分析，采用国际通用的全科医生门诊内容编码工具（DOC编码），对我国基层全科医生门诊问诊的临床预防服务项目进行结构化和定量化描述。结果　在649名门诊患者问诊中，医生为186名（28.7%）患者的门诊问诊提供了至少一种临床预防服务项目；仅有3名医生为≥50%的门诊问诊提供了至少一种临床预防服务项目。营养咨询与建议、疾病筛查和疫苗接种建议和睡眠咨询与建议三类服务项目的患者覆盖率分别为13.4%、9.4%、5.6%，在提供了上述各项服务的患者中，该项服务平均问诊时长分别为（17.61±18.37）、（15.77±15.62）、（13.53±18.59）s。结论　我国基层全科医生在门诊问诊过程中提供临床预防服务的水平较低，与国外存在较大差距。

关键词: 全科医生, 临床预防服务, 问诊, 观察性研究