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The Research Environment and Reward Preferences of Primary Care Practitioners in the Shanghai General Practice Research Network:a Mixed Methods Study

  

  1. 1.Department of General Practice,Yangpu Hospital Affiliated to Tongji University,Shanghai 200090,China 2.Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China 3.Clinical Research Center for General Practice,School of Medicine,Tongji University,Shanghai 200090,China 4.School of Public Health and Preventive Medicine,Monash University,Melbourne 3168,Australia 5. School of Medicine,Faculty of Medicine and Health Sciences,University of Keele,Keele,Staffordshire ST5 5BG,UK
  • Contact: YU Dehua,Chief physician/Doctoral supervisor;E-mail:ydh1404@sina.com

上海全科医学科研网络中基层医务人员的研究环境和回报偏好:一项混合方法研究

  

  1. 1.200090 上海市,同济大学附属杨浦医院全科医学科 2.200090 上海市,上海市全科医学与社区卫生发展研究中心 3.200090 上海市,同济大学医学院全科医学研究中心 4.3168 澳大利亚墨尔本市,蒙纳士大学公共卫生与预防医学学院 5. ST5 5BG 英国斯塔福德郡,基尔大学医学与健康科学学院
  • 通讯作者: 于德华,主任医师/博士生导师;E-mail:ydh1404@sina.com
  • 基金资助:
    同济大学附属杨浦医院博士科研启动项目(BS-202404);上海市卫健委卫生健康政策研究项目(2023HP28,2023HP71);上海市领军人才项目(YDH-20170627)

Abstract: Background Practice-Based Research Networks(PBRN)enable collaborative primary care research. In China,since 2023,healthcare reforms emphasizing community-based primary care have spurred PBRN development. However,the research environment and incentives for primary care practitioners(PCPs)to belong to these networks remain under-explored. Objective This study investigates the research environment and support needed by PCPs in the Shanghai General Practice Research Network(SGPRN)to maximize PBRN development in China. Methods This study employed a mixed-methods explanatory sequential design. The quantitative component involved an online survey of 145 PCPs from the SGPRN,selected through purposive sampling,who expressed interest in research activities. The survey collected data on their background,research capabilities,research environment,and preferred incentives for participating in PBRN-organized research. Descriptive statistical analysis and the Kano Model were used to analyze and categorize the data. The qualitative component involved one focus group discussion and 21 semi-structured interviews with 24 PCPs from the survey sample,selected to validate and complement the quantitative findings. Interview data were analyzed iteratively using a qualitative descriptive approach. Quantitative and qualitative data were integrated through joint display and meta-synthesis. Results Most PCPs(85%)reported a supportive research environment,with 69% integrating research with clinical practice. However,only 43% had sufficient research time,and 50% access to collaborators. Qualitative findings revealed limited professional support and fragmented time as key barriers. Incentives required included opportunities to acquire research skills,leading personally relevant studies,securing primary authorship,and accessing shared data,all contingent on transparent collaboration and trust. All these preferences aligned with institutional performance-driven policies. Conclusion The SGPRN research environment is currently neutral to slightly favorable,strongly driven by performance-oriented policies. PCPs participate in PBRN research primarily to enhance their research expertise and achieve publication-driven career advancement. Despite these motivations,China’s PBRN need to draw on international strategies,enhancing research training,fostering collaborative platforms,and prioritizing practice-oriented,high-quality research to improve patient care,while aligning with local general practitioners’ professional aspirations for advancing the discipline and clinical practice,to reconcile and overcome the limitations of output-focused,impractical research policies.

Key words: Primary care research, Practice-based research networks, Research capacity building, General practitioners, Research collaboration, General practice

摘要: 背景 全科医学科研网络(PBRN)将医务人员与研究人员连接,共同开展以全科医学和社区健康为导向的研究。自2023年以来,我国已创建了多个本土PBRN,但对其中的基层医务人员所处的科研环境和他们所期望的回报仍了解不足。目的 本研究旨在探索在初创的上海全科医学科研网络(SGPRN)中,对于从事全科医学和基本医疗研究怀有兴趣的基层医务人员所面临的科研环境,以及他们希望通过相关科研活动获得的回报。上述工作将为我国PBRN的组织构建、科研能力提升及科研设计提供相应信息,从而支持制定相应的策略。方法 本研究采用混合方法研究的解释性时间序列设计。定量部分通过目的性抽样,于2024-10-12,对SGPRN中有意参与科研活动的145名基层医务人员进行了在线电子问卷调查,收集背景信息、科研能力、所处的科研环境及参加PBRN组织的相关研究时希望得到的回报相关的信息,并使用描述统计分析和卡诺模型(Kano Model)对其进行分析和分类。定性部分在定量部分的被调查者中,选取了24名基层医务人员,运用定性描述方法进行了1次焦点小组访谈和21次半结构式访谈,并对访谈数据进行迭代分析,以对定量数据进行验证和补充。最终通过联合展示和元合成的方法整合了定量和定性数据。结果 在参与调查的基层医务人员中,84.83%(123/145)报告所在的社区卫生服务中心提供了有利于开展科研工作的环境,68.97%(100/145)报告他们的科研工作与临床工作可以紧密结合,66.89%(97/145)报告易于获得学习科研知识和技能的资源,60%(87/145)报告拥有开展科研工作所需的资源,50.34%(73/145)报告可以找到科研合作伙伴,42.75%(62/145)报告拥有充足的科研时间。定性结果确证了全部定量结果,并对其进行了一定程度的拓展性补充。基层医务人员最希望从科研网络获得的回报,包括获得开展科研工作的知识和技能、主持完成对自己感兴趣的问题的研究、获得主要的作者署名、以及在可以运用数据的情况下获得共享数据,上述回报均与社区卫生中心乃至医疗卫生体系的科研激励政策设计密切相关。此外,定性结果还强调,前置、公开、透明的合作规则,以及参与者之间的相互信任,是吸引基层医务人员参与PBRN组织的科研工作的必要条件。结论 本研究发现,SGPRN中的社区医务人员所处的科研环境处于中性而略偏有利的情况,并被当前医疗卫生机构科研激励和职业发展政策显著影响。基层医务人员希望在科研工作中取得的回报,聚焦于克服自身专业科研知识和技能不足的限制,以取得科研绩效产出这一根本目的。上述发现提示,我国PBRN未来的发展应在借鉴国际成熟经验,为基层医务人员提供支持其提升科研知识和技能的系统资源的同时,制定相应策略,以缓解和克服当前科研政策对全科医学和基本医疗研究的消极影响,并开展以改进实践、造福患者为主要导向的,求真、务实、高质量的研究。

关键词: 基本医疗研究, 全科医学科研网络, 科研能力建设, 全科医生, 科研合作, 全科医学

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