社区基层医疗卫生机构全科医生对医防融合的认知评价

Evaluation of General Practitioners’ Perception of Medical-Preventive Integration in Community Primary Health Care Organizations

摘要: 目的：了解和评价浦东新区基层医疗卫生机构全科医生对医防融合的主观认识，并分析其影响因素，为浦东新区社区家庭医生团队实施慢性病医防融合管理提供参考。方法：于2024年8~9月采用医防融合认识评价调查表针对浦东新区4类地区采取分层随机抽样，共抽取12家社区共计242名全科医生进行调查，问卷采用likert四级评分表，问卷运用因子分析来进行结构效度检测，此外针对标准化后的综合认知得分进行描述性统计、单因素及多因素分析来检验在年龄、性别、学历、工作年限、地区划分和有无行政职务方面的差异。结果：新区全科医生医防融合主观认识的调查结果经过因子分析降维后得出环境支持公因子、科室层次合作公因子和个人层面认知公因子，3公因子得分进行转化分别为3.15 ± 0.79、2.82 ± 0.70和3.14 ± 0.653，累积方差贡献率为60.947%，进行单因素和多因素分析显示年龄46岁以上、文化程度硕士及以上、职称为副高及以上、工作年限21年及以上以及有行政职务的全科医生其得分高，P < 0.05差异有统计学意义。结论：基层医疗机构全科医生感知到医防融合环境支持、科室间协作不强，个人层面对于医疗和预防的认知还存在较强的专业界限，未来基层医疗机构管理者还需要通过加强跨学科培训、优化人力资源配置、强化电子信息系统建设，并实施精细化的团队协作和绩效激励制度，以促进医防融合策略的全面实施和慢性病服务的持续改进。

Abstract: Objective: To understand and evaluate the subjective knowledge of GPs in primary healthcare organizations in Pudong New Area on the integration of healthcare and prevention, and analyze its influencing factors, in order to provide reference for the implementation of the integration of healthcare and prevention management of chronic diseases by community family doctor teams in Pudong New Area. Methods: In August-September 2024, a stratified random sample of 242 GPs from 12 communities in the Pudong New Area was surveyed using the Medical Prevention Integration Awareness Evaluation Questionnaire (MPIEQ). The questionnaire was scored on a likert scale, and the questionnaire was analyzed using factor analysis for structural validity, and the standardized composite cognitive scores were subjected to descriptive statistics, single-factor and multifactor analyses to examine the effects of age, sex, and gender. In addition, descriptive statistics, one-way and multifactor analyses were conducted to examine the differences in age, gender, education, years of experience, regional division, and the presence or absence of administrative positions in the standardized composite cognitive scores. Results: The results of the survey on the subjective knowledge of medical integration among general practitioners in the new district were reduced by factor analysis to obtain the environmental support, department-level cooperation, and individual-level cognition public factors, and the scores of the three public factors were transformed to be 3.15 ± 0.79, 2.82 ± 0.70, and 3.14 ± 0.653, respectively, with a cumulative ANOVA contribution rate of 60.947%. Univariate and multivariate analyses showed that GPs who were older than 46 years old, had a master’s degree or higher in education, had a title of associate professor or higher, had 21 or more years of experience, and had an administrative position had high scores, and the difference was statistically significant at P < 0.05. Conclusion: GPs in primary care perceived a supportive environment for medical and preventive integration, weak interdepartmental collaboration, and a strong personal-level perception of the importance of medical care and prevention are still perceived as having strong professional boundaries. In the future, primary care managers also need to strengthen interdisciplinary training, optimize the allocation of human resources, enhance the construction of electronic information systems, and implement a refined teamwork and performance incentive system to promote the full implementation of the healthcare and prevention integration strategy and the continuous improvement of chronic disease services.