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目的中国自2009年起开展社区卫生服务,截至2014年已建成社区卫生服务中心8 669家,拥有社区卫生服务工作者30万人。然而,至社区卫生服务中心就诊的患者数并不多,因为人们对全科医生缺乏信任,但对专科医生过度依赖。方法于2015年9—12月,采用分层随机抽样法,按社区卫生服务中心在城市和郊区的分布比例(2∶1)在中国东、中、西部地区抽取样本社区卫生服务中心,并采用不同问卷对在其工作的资深临床医生和全科医生进行调查。两套问卷内容均涉及所在社区卫生服务中心的服务人口特征、开办的临床和健康教育活动情况。158例资深临床医生和3 580例全科医生对调查进行了有效应答,问卷有效应答率分别为84%和86%。结果社区卫生服务中心的中位医生数为8例、中位护士数为13例,但仅半数医生注册为全科医生,极少数护士接受过专业的全科培训。98%的社区卫生服务中心配有听诊器,97%配有血压计,但仅43%配有检眼镜,64%配有妇科检查仪器。社区卫生服务中心倾向于有选择地向部分慢性病患者提供医疗服务。全科医生每天接诊的中位患者数为12.5例。多因素分析结果显示,在举办主体为私立医院的社区卫生服务中心、配有药剂师和护士的社区卫生服务中心,全科医生的每日接诊患者数较多。结论中国拥有规模较大的、以年轻人为主的全科医疗服务团队,并配有持续性专业培训;社区卫生服务中心配有基础医疗设备,但仅少数可为患者提供多种常见病的综合性医疗服务;社区卫生服务中心就诊患者数仍较少。
Objective China has started to provide community health services since 2009. As of 2014, 8,669 community health service centers and 300,000 community health service workers have been established. However, there are not many patients attending CHCs because people lack trust in GPs but over-reliance on specialists. Methods From September to December 2015, stratified random sampling method was used to sample community health centers in the eastern, central and western regions of China according to the distribution ratio of community health centers in cities and suburbs (2: 1) Different questionnaires survey experienced clinicians and general practitioners in their work. The contents of the two questionnaires involve the population characteristics of the community health service center and the clinical and health education activities conducted. A total of 158 senior clinicians and 3,580 GPs responded effectively to the survey, with valid responses of 84% and 86%, respectively. Results The number of mid-level doctors in community health centers was 8 and that of mid-level nurses was 13. However, only half of the doctors were registered as general practitioners and a very small number of nurses received professional general training. 98% of community health centers have stethoscopes, 97% have sphygmomanometers, but only 43% have ophthalmoscopes and 64% have gynecological exams. Community health service centers tend to selectively provide medical services to some patients with chronic diseases. The median number of GP visits per day was 12.5. In the multivariate analysis, community health centers with private hospitals, community health centers with pharmacists and nurses were held and general practitioners had more admissions per day. Conclusion China has a large, mostly young-focused general practice service team with continuing professional training. Community health centers are equipped with basic medical equipment, but only a few can provide patients with a comprehensive list of common diseases Sexual health services; Community health service centers still have fewer patients.