Abstract: Background With the nationwide implementation of the "Healthy China" strategy, the health disparities between urban and rural populations have narrowed. However, there is still a mismatch between the medical service capacities of village doctors and the medical service needs of rural residents. Village doctors are the first point of contact for rural residents' health concerns. Objective This study aims to evaluate the current medical service capacities of village doctors across the eastern, central, and western China, identify their strengths and weaknesses, and propose targeted strategies for improvement. The findings will provide references for building the capacities of primary health care professionals in rural areas. Methods In August 2020, the research group used the mixed methods of multi-stage stratified cluster sampling and typical sampling to select 3 916 village doctors from five provinces in the eastern, central, and western China. By distributing questionnaires on the “wjx.cn” platform, an online survey was conducted on the current status of the medical service capacities of village doctors from seven aspects: diagnosis and treatment of common and frequently occurring diseases, emergency response to critical conditions, standardized use of medical devices, community rehabilitation guidance, medical collaboration, medical document writing, and traditional Chinese medicine services. Results Among the 3 916 village doctors included in the analysis, 2 925 (74.7%) were able to diagnose and treat common and frequently occurring diseases. The competence rates of village doctors were highest in the central region (81.2%), followed by the eastern region (79.6%), and lowest in the western region (59.1%). 2 098 (53.6%) had the ability of emergency response to critical illnesses. The competence rates of village doctors were highest in the central region (61.6%), followed by the eastern region (52.3%), and lowest in the western region (40.1%). 2 081 (53.1%) could use medical devices in a standardized way. The competence rates of village doctors were highest in the central region (62.3%), followed by the eastern region (53.8%), and lowest in the western region (36.3%). 2 073 (52%) had the ability to provide community rehabilitation services. The competence rates of village doctors were highest in the central region (59.7%), followed by the eastern region (53.6%), and lowest in the western region (40.3%). 3 120 (79.7%) were capable of writing medical documents.The competence rates of village doctors were highest in the central region (82.6%), followed by the eastern region (82.0%), and lowest in the western region (72.7%). 2 190 (55.9%) possessed the ability of medical collaboration.The competence rates of village doctors were highest in the central region (61.0%), followed by the eastern region (57.9%), and lowest in the western region (45.3%). 2 443 (62.4%) were able to provide traditional Chinese medicine services. The competence rates of village doctors were highest in the western region (64.8%), followed by the central region (62.7%), and lowest in the eastern region (58.7%). Conclusions Village doctors possess adequate medical service skills, essentially catering to the general medical service needs of rural residents. The overall medical service capacities should be improved, and there exist notable discrepancies in medical service capacities across various regions. It is recommended to strengthen the training of village doctors so as to enhance the overall quality of the primary health care professionals in rural areas, improve the construction of hardware facilities and information technology for village-level medical services, and promote the effective implementation of the first visit system at the primary health care level.

Key words: Rural doctors, Medical service, Service capacity, Cross-sectional studies

摘要： 背景 随着健康中国战略的全面推进，城乡居民健康差异逐渐缩小。但村医作为农村居民健康问题的第一接触点，其医疗服务能力与居民的医疗服务需求仍有差距。目的 调查我国东、中、西部村医医疗服务能力现状，分析其能力特点和主要不足，探讨村医医疗服务能力提升策略，为农村基层卫生人才能力建设提供参考。方法 2020年8月，课题组采用多阶段抽样和典型抽样相结合的方法，在东、中、西部五省份共抽取 3 916 名村医。通过在“问卷星”平台发放问卷，从常见病诊治、危急重症应急处置、规范用械、社区康复指导、医疗协同、医疗文书书写和中医药服务七个方面，对抽取的村医进行医疗服务能力现状线上问卷调查。结果 纳入分析的 3 916 名村医中，2 925 名（74.7%）村医具备常见病、多发病诊治能力，其中中部地区村医能力具备率较高（81.2%），东部次之（79.6%），西部最低（59.1%）；2 098 名（53.6%）村医具备危急重症应急处置能力，其中中部地区村医能力具备率较高（61.6%），东部次之（52.3%），西部最低（40.1%）；2 081 名（53.1%）具备规范使用医疗器械能力，其中中部地区村医能力具备率较高（62.3%），东部次之（53.8%），西部最低（36.3%）；2 073 名（52.9%）具备社区康复服务能力，其中中部地区村医能力具备率较高（59.7%），东部次之（53.6%），西部最低（40.3%）；3 120 名（79.7%）具备医疗文书书写能力，其中中部地区村医能力具备比例较高（82.6%），东部次之（82.0%），西部最低（72.7%）；2 190 名（55.9%）具备医疗服务协同能力，其中中部地区村医能力具备比例较高（61.0%），东部次之（57.9%），西部最低（45.3%）；2 443 名（62.4%）具备中医药服务能力，其中西部地区村医能力具备率较高（64.8%），中部次之（62.7%），东部最低（58.7%）。结论 村医医疗服务技能具备较好，基本满足农村居民一般医疗服务需要；综合处置能力有待提升，不同地区能力差异显著。需加大村医能力培训力度，提高队伍整体素质，完善村级医疗服务硬件设施建设与信息化建设，推进基层首诊制度的有效开展。

关键词: 乡村医生, 医疗服务, 服务能力, 横断面研究