吴慧超 黄薇 凌小媛 滕香宇

摘 要 目的：評估“全科-专科”联合查房对社区全科医师糖尿病专科分析应诊能力的提升作用。方法：于2015年10月至2017年10月在上海交通大学附属仁济医院南院-浦江社区卫生服务中心医联体开展糖尿病“全科-专科”联合查房，共有34名全科医师参与了此项工作。在开展“全科-专科”联合查房前、后分别对该34名医师进行糖尿病知识及糖尿病分析应诊能力的评估。结果：根据参与糖尿病“全科-专科”联合查房的次数将全科医师分为参与次数不满5次组、5～9次组及大于等于10次组。在糖尿病知识评估中，并发症筛查及处理和血糖监测这些操作性较强、平日实践较多的部分得分提升较快，与培训前相比，培训后得分差异有统计学意义（P<0.05）在糖尿病分析应诊能力评价中，首次参与联合查房时，全科医师的分析应诊能力评估得分均较低，3组间基线水平差异无统计学意义（P>0.05）。参与联合查房10次以上组，其末次查房时糖尿病分析应诊能力的评估结果有了显著提升，差异有统计学意义（P<0.05）。结论：糖尿病专科知识培训方式对医师的诊疗能力提升有限，但糖尿病“全科-专科”联合查房有助于提升社区全科医师的糖尿病分析应诊能力。

关键词 教学查房；全科医师；专科医师

中图分类号：R197.32 文献标志码：A 文章编号：1006-1533（2018）24-0018-03

Evaluation of the effect of “general practitioner-specialist” joint ward rounds to improve the ability of diabetes diagnosis and treatment of the general practitioners

WU Huichao1， HUANG Wei2， LING Xiaoyuan2， TENG Xiangyu3（1.Pujiang Community Health Service Center of Minhang District， Shanghai 201112， China； 2. Department of General Medical of Pujiang Community Health Service Center of Minhang District， Shanghai 201112， China； 3.Department of Endocrinology of South Campus of Renji Hospital， School of Medicine of Shanghai Jiao Tong University， Shanghai 201112， China）

ABSTRACT Objective： To evaluate the role of “general practitioner-specialist” joint ward rounds in improving the ability of diabetes diagnosis and treatment of the community general practitioners. Methods： From October 2015 to October 2017， diabetes “general practitioner-specialist” ward rounds were conducted in the medical treatment alliance of South Campus of Renji Hospital， School of Medicine of Shanghai Jiao Tong University-Pujiang Community Health Service Center of Minhang District and a total of 34 general practitioners participated in the work. The 34 physicians were assessed for diabetes knowledge and ability of diabetes diagnosis and treatment before and after the general practitioner-specialist ward rounds. Results： The general practitioners were divided into the group of less than 5 times， the group of 5-9 times and the group of more than or equal to 10 times according to the times of participating in the joint ward rounds of “general practitioner-specialist”. In the assessment of diabetes knowledge， the scores of the operative screening and treatment and blood glucose monitoring， which had strong operability and more practice on weekdays， were improved faster. Compared with before training， the scores after training were statistically significant（P<0.05）. In the evaluation of the ability of diabetes diagnosis and treatment， the scores of ability of diabetes diagnosis and treatment of the general practitioners were low when they participated in the joint ward round for the first time， and there was no significant difference in the baseline level among the three groups（P>0.05）. Participating in the joint ward rounds for more than 10 times， the evaluation results of the ability of diabetes diagnosis and treatment at the last round ward were significantly improved， and the difference was statistically significant（P<0.05）. Conclusion： The diabetes specialist training method has limited improvement in the ability of diabetes diagnosis and treatment. However， diabetes “general practitionerspecialist” ward rounds can help improve the ability of diabetes diagnosis and treatment of the community general practitioners.

KEY WORDS teaching round； general practitioner； specialist physician

2013年的统计结果显示，中国居民糖尿病患病率为10.9%，糖尿病前期患病率为35.7%，虽然较2010年的统计结果稍有下降，但我国仍有1.18亿的糖尿病患者，成为全世界糖尿病患者人数最多的国家[1-2]。以社区医疗机构为防控基地，实现“社区首诊、双向转诊、急慢分治、上下联动”是缓解糖尿病就医矛盾的重要途径之一[3]。然而在实践过程中，各种新老问题交错，社区全科医师水准参差不齐、无法满足糖尿病患者的较高诊疗要求是其中一个亟待解决的关键问题。……