基层全科医生集中培训糖尿病知识存在的问题及影响因素分析
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摘要
目的了解基层全科医生集中培训糖尿病知识存在的问题,探索有效的培训方式。方法选取2017年1月北京市平谷区平谷镇、大华山镇等13个社区参加的由首都医科大学附属北京友谊医院平谷医院内分泌科举办的1次2学时《2013年版中国2型糖尿病防治指南》集中培训活动基层全科医生129名。根据培训内容设计糖尿病防治指南知识测试题,制定题干相同但答案顺序不同的试卷A(培训前)和试卷B(培训后),在培训前后对参训医生进行测试。采用配对t检验、成组t检验或单因素方差分析2次测试的错题数或错题变化量,了解培训效果及存在问题,采用多因素方差分析培训效果的影响因素。结果 129名医生参加培训,收回127名医生的有效试卷193份,其中66名同时完成A、B卷,46名只完成A卷,15名只完成B卷。112份A卷错题数(7.97±3.86),81份B卷错题数(4.68±3.17),错题数明显减少(t=6.30,P<0.01)。66名同时完成A、B卷,A卷错题数(8.03±4.04),B卷错题数(4.45±3.21)(t=8.68,P<0.01),培训前后变化明显,其中女性错题数减少明显。说明1次集中培训对基层医生糖尿病知识水平的提高有帮助。分析错题数的影响因素,结果发现,非临床专业、职称偏低人员培训后错题数明显减少,非临床专业人员培训效果更好。结论基层全科医生集中培训糖尿病知识总体上有效果,但缺乏足够重视,不能全程参加培训。需探索其他培训形式或根据基层全科医生的不同特点制定个性化培训方案,尤其对非临床专业和职称偏低人员进行重点培训。
Objective To investigate the problems and influencing factors of centralized training on diabetes knowledge in general practitioner at the grassroots level and to explore effective training methods.Methods A total of 129 general practitioner(GPs)from 13 communities including Pinggu Town,Dahuashan Town,Pinggu District,and Beijing were enrolled in this study.All the GPs participated in a two-hours training program entitled "2013 edition of guidelines for prevention and treatment of type 2 diabetes in China"organized by the Department of Endocrinology,Pinggu Hospital,Beijing Friendship Hospital,affiliated to Capital Medical University in Jan 2017.Two diabetes knowledge tests(A and B)with the same multiple choice questions but different answer orders were given to make examination before and after the training.The performance on the test were evaluated by samples paired t test and group t test to compare the number of wrong items before and after training.ANOVA test was applied to analyze the factors influencing the training effect. Results A total of 129 GPs participated in the training,and 127 GPs were enrolled in this study with 193 valid tests collected before and after the training.There were 66 GPs finished both test A and B,46 GPs completed only test A,and 15 GPs completed only test B.The mean number of incorrect answers in 112 Atests(before the training)was(7.97±3.86),while the mean number of incorrect answers in 81 Btests(after the training)was(4.68±3.17),which showed a significant improvement after training(t=6.30,P<0.01).Of 66 GPs who completed both test A and B,the mean number of incorrect answers in test A and test B were(8.03±4.04)and(4.45±3.21),respectively,the improvement was significant(t=8.68,P<0.01).The number of incorrect answers in women reduced obviously.The number of incorrect answers was significantly reduced,which means that one-time centralized training can help improving the knowledge of diabetes in GPs in rural China.Analysis of the influencing factors for incorrect answers showed that the number of incorrect answers was significantly reduced in subjects with non-clinical backgrounds and low-ranking medical titles.The effect of training was better in subjects with non-clinical backgrounds. Conclusion Centralized training is generally effective in improving the knowledge of diabetes among GPs.Some GPs do not pay enough attention to the importance of training and cannot insist on the whole process.We need to look for other forms of training or develop individualized training programs based on different characteristics of the GPs,especially for those non-clinical or low-ranking medical staff.
Objective To investigate the problems and influencing factors of centralized training on diabetes knowledge in general practitioner at the grassroots level and to explore effective training methods.Methods A total of 129 general practitioner(GPs)from 13 communities including Pinggu Town,Dahuashan Town,Pinggu District,and Beijing were enrolled in this study.All the GPs participated in a two-hours training program entitled "2013 edition of guidelines for prevention and treatment of type 2 diabetes in China"organized by the Department of Endocrinology,Pinggu Hospital,Beijing Friendship Hospital,affiliated to Capital Medical University in Jan 2017.Two diabetes knowledge tests(A and B)with the same multiple choice questions but different answer orders were given to make examination before and after the training.The performance on the test were evaluated by samples paired t test and group t test to compare the number of wrong items before and after training.ANOVA test was applied to analyze the factors influencing the training effect. Results A total of 129 GPs participated in the training,and 127 GPs were enrolled in this study with 193 valid tests collected before and after the training.There were 66 GPs finished both test A and B,46 GPs completed only test A,and 15 GPs completed only test B.The mean number of incorrect answers in 112 Atests(before the training)was(7.97±3.86),while the mean number of incorrect answers in 81 Btests(after the training)was(4.68±3.17),which showed a significant improvement after training(t=6.30,P<0.01).Of 66 GPs who completed both test A and B,the mean number of incorrect answers in test A and test B were(8.03±4.04)and(4.45±3.21),respectively,the improvement was significant(t=8.68,P<0.01).The number of incorrect answers in women reduced obviously.The number of incorrect answers was significantly reduced,which means that one-time centralized training can help improving the knowledge of diabetes in GPs in rural China.Analysis of the influencing factors for incorrect answers showed that the number of incorrect answers was significantly reduced in subjects with non-clinical backgrounds and low-ranking medical titles.The effect of training was better in subjects with non-clinical backgrounds. Conclusion Centralized training is generally effective in improving the knowledge of diabetes among GPs.Some GPs do not pay enough attention to the importance of training and cannot insist on the whole process.We need to look for other forms of training or develop individualized training programs based on different characteristics of the GPs,especially for those non-clinical or low-ranking medical staff.
引文
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[6]赵欣.慢病管理的现状与发展方向.中国临床医生,2012,40:42-44.
[7]梁勇,张柠.国外医疗服务体系对完善我国分级诊疗体系的启示与借鉴.中国医院,2015,19:50-52.
[8]中华人民共和国国家卫生健康委员会.卫生部办公厅关于印发《基层医疗卫生机构全科医生转岗培训大纲(试行)》的通知.2011.[2017-09-19].http://www.nhfpc.gov.cn/zwgkzt/wsbysj/201101/50340.shtml.
[9]Herring R,Pengilley C,Hopkins H,et al.Can an interprofessional education tool improve healthcare professional confidence,knowledge and quality of inpatient diabetes care:A pilot study?.Diabet Med,2013,30:864-870.
[10]薄海燕,王伟,陶海琦,等.社区医生自学《糖尿病防治知识》读本优化知识教育方案效果评价.中国初级卫生服务保健,2009,23:35-36.
[2]侯清涛,李芸,李舍予,等.全球糖尿病疾病负担现状.中国糖尿病杂志,2016,24:92-96.
[3]廖涌.中国糖尿病的流行病学现状及展望.重庆医科大学学报,2015,40:1042-1045.
[4]Gaede P,Vedel P,Larsen N,et al.Multifactorial intervention and cardiovascular disease in patients with type 2diabetes.NEngl J Med,2003,348:383-393.
[5]中华人民共和国国家卫生健康委员会.国家基本公共卫生服务规范(2009年版).[2017-09-19].http://www.nhfpc.gov.cn/zwgk/wtwj/201304/b175eb09dfd240f6bae36d2fb67c8619.shtml.
[6]赵欣.慢病管理的现状与发展方向.中国临床医生,2012,40:42-44.
[7]梁勇,张柠.国外医疗服务体系对完善我国分级诊疗体系的启示与借鉴.中国医院,2015,19:50-52.
[8]中华人民共和国国家卫生健康委员会.卫生部办公厅关于印发《基层医疗卫生机构全科医生转岗培训大纲(试行)》的通知.2011.[2017-09-19].http://www.nhfpc.gov.cn/zwgkzt/wsbysj/201101/50340.shtml.
[9]Herring R,Pengilley C,Hopkins H,et al.Can an interprofessional education tool improve healthcare professional confidence,knowledge and quality of inpatient diabetes care:A pilot study?.Diabet Med,2013,30:864-870.
[10]薄海燕,王伟,陶海琦,等.社区医生自学《糖尿病防治知识》读本优化知识教育方案效果评价.中国初级卫生服务保健,2009,23:35-36.