国内外全科医生培养的比较研究

全科医生是为个体、家庭和社区提供基本的、连续的、综合的医疗卫生保健服务的医生[1]。全科医生作为高质量初级卫生保健的提供者,被认为是居民健康的最佳守门人[2]。目前全科医生制度已在50多个国家和地区实施,全科医生占医生总数的30%～60%,例如英国、美国、澳大利亚、加拿大、古巴等国,都已开展了家庭医生服务模式[3,4]。通过各国全科医生培     

全科医生社区实践基地建设的探讨

根据我国目前的社会经济、卫生事业、医学教育事业的实际情况,发展社区卫生服务所需的全科医生,不可能完全由本科医学生毕业后经全科医学教育而来,更多的是基层医院的专科医生经培训转型成为全科医生,因此,全科医生的培训工作任重而道远。从2000年开始浙江省全面开展全科医师培训工程,包括全科住院医师规范化培训、全科医生转岗培训、全科骨干医师培训”。根据《浙江省住院医师规范化培训基地认定办法（试行）》和《浙江省住院医师规范化培训基地管理办法（试行）》的通知精神,培训基地分为临床培训基地和社区实践基地,社区实践基地不设培训学科,与临床培训基地的全科医学学科共同承担住院医师规范化培训的社区实践任务。     

全科医生对临终关怀的知行信调查

目的了解全科医生对临终关怀的认知、态度及行为,并分析其影响因素,为全科医生的培训和行政部门制定家庭临终关怀策略提供参考依据。方法采用方便取样的方法对福建省全科医生规范化培训班74位成员进行关于临终关怀知行信的问卷调查。结果 50%的全科医生只是听说但不了解临终关怀,全科医生对临终关怀的态度及行为得分偏低。结论全科医生对临终关怀的认知不足,临终关怀的实行对于全科医生还存在一定的难度,建议加强临终关怀的教育,以指导全科医生更好地进行临终关怀。     

农村全科医生抗菌药物应用中存在的几个问题

<正>为了解农村全科医生应用抗菌药物的情况,我们于2010年9月～11月对567位在商丘医学高等专科学校培训的农村全科医生进行调查,发现抗菌药物应用过程中存在着不少问题,现将结果报道如下。1抗菌药物应用指征掌握不严1.1滥用抗菌药物如内科的脑血管疾病,儿科的病毒性感染等,这些抗菌药物治疗根本无效的疾病,均使用了抗菌药物。以致造成大量药品浪费,同时     

民营口腔医院绩效管控的实践

民营口腔医院建立合理、有效、完整的绩效管控体系是市场经济下医院管理的核心和关键。多维度的绩效管控可以拓宽人力资源管理,促进民营口腔医院全方位的发展,进一步促进口腔医院实现科学化的绩效管理道路,促进民营口腔医院人力资源管理的良性可持续发展。     

加强基层部队卫生技术干部全科医生培训的探讨

本文阐述了加强基层部队卫生技术干部全科医生培训的必要性,提出了具体措施办法：确立培训目标,创新培训模式,合理设置课程,遴选适宜师资,强化管理考核。     

专科培训对沙井街道全科医生脑卒中防治管理能力的影响分析

目的：考察专科培训对沙井街道全科医生对脑卒中管理能力水平的影响。方法随机选取沙井街道全科医生50人给予专科培训作为研究组，并选取未接受专科培训的全科医生作为对照组，通过自行设计的调查问卷对两组医生的脑卒中防治管理能力进行评定。结果共发放调查问卷100份，回收有效答卷95份，回收率为95.0%。研究组答卷总分显著高于对照组（P<0.01），研究组脑卒中的识别和处理得分显著高于对照组（P<0.01），研究组脑卒中二级预防得分显著高于对照组（P<0.01）。结论实施专科培训可以有效提高全科医生的脑卒中识别和处理能力以及脑卒中二级预防能力，有效改善社区全科医生的脑卒中防治管理能力。     

我院药师绩效管理体系的建立与实践

目的:建立能够有效引导药师价值实现的绩效管理体系。方法:采用行动学习法,通过不断质疑、反思、执行,在我院建立逐级深入的药师绩效管理体系;并以门诊服务满意度、药师会诊次数为指标进行绩效管理体系实施后的效果评价。结果:我院于2013-2018年,逐步建立了团队绩效(以月末团队质控检查结果、团队负责人月度工作报告等为指标)、个人绩效(以药师业绩、工作态度和能力等为指标)、岗位胜任力(考核指标随药师岗位变化,如考核临床药师用药咨询等)3个层次的绩效管理体系。绩效管理的建立,提高了团队积极性、服务满意度,优化了人才结构,扩大了药师专业能力及影响力,改善了药师收入结构;与2013年比较,2018年门诊服务满意度由88%提升至95%;与2016年比较,2018年药师会诊次数由原来的30次增加到92次;药师可通过对临床科室提供药学服务增加收入。结论:所建立的药师绩效管理体系能有效提高药师的积极性,促进药师工作的开展。     

“全科医生—社区”模式在人口老龄化社会的作用

目的分析"全科医生—社区"模式在人口老龄化社会的作用。方法就现如今社区医疗卫生服务机构存在的问题进行分析,探讨我国推行"全科医生—社区"卫生保健服务方式的必要性。结果由于计划生育政策的影响以及人均寿命延长,中国已经逐渐步入人口老龄化社会。人口老龄化问题将给社会带来一系列新问题。结论医疗卫生保健是主要问题之一。应取长补短,完善我国的"全科医生—社区"模式。     

澳大利亚全科医学教育对上海全科医生培养的启示

全科医生是家庭医生制服务的主力军,但目前社区卫生服务中心普遍存在全科医生数量不足和能力不强的问题。本文通过介绍澳大利亚全科医生的培养、职业培训和持续职业发展项目,结合上海市全科医生的现状,对全科医生的继续教育和业务培训提出建议。     

Attitudes and practices of general practitioners training to work with drug-using patients

This study assessed the current attitudes, knowledge and practices of 26 inner metropolitan GPs training to work with drug-users. In comparison to nicotine, alcohol and benzodiazepine, illicit drugs (such as opiates and amphetamines) were associated with significantly lower GP confidence, self-reported effectiveness and general knowledge. GPs were also less likely to ask their patients about illicit drug-use than other types of drugs. Older GPs were more confident, believed themselves to be more effective but had less general knowledge about all drug types than GPs under 40. Female doctors also reported lower levels of confidence. Self-reported effectiveness and confidence did not show any association with accuracy of general knowledge about drugs. Although most GPs were very positive about their role in working with drug-users, GPs tended to associate wanting to work with drug-users with professional responsibility, rather than personal interest. These findings suggest that training programmes for GPs in the area of drug-use need to be tailored to account for differing knowledge bases, but also tackle the more difficult task of addressing attitudes and self-perceptions of the role GPs play in dealing with drug-use.     

Effects of item sequence on the performance of the AUDIT in general practices

BACKGROUND: One important task in identifying subjects with alcohol use disorders (AUDs) in the general medical practice setting is the development of effective screening instruments. Sensitivity of screening questionnaires might differ according to the introductory items. This study compares two versions of the alcohol use disorders identification test (AUDIT) with varied item sequence randomly applied to patients derived from a sample of general practitioners (GP) patients. METHODS: Participants were recruited from general practices in two northern German cities; they received two different versions of the AUDIT, one group receiving the original version starting with three items addressing frequency and quantity of alcohol use (AUDIT1), and a second group receiving a version in which these items were put at the end of the questionnaire (AUDIT2). In total, 10.803 screenings were conducted (refusal rate: 5%). Alcohol use disorders were diagnosed using the Munich-Composite International Diagnostic Interview (M-CIDI). RESULTS: Logistic regression analysis revealed that AUDIT1 subjects had higher scores in the consumption items of the AUDIT, whereas AUDIT2 subjects scored higher on items focussing on symptoms of alcohol dependence or abuse. CONCLUSION: The sequence upon which items of the AUDIT are presented influences the report of drinking patterns and symptoms of alcohol use disorders in GP patients.     

Attitudes of New Zealand general practitioners to alcohol-related problems

The attitudes of a self-selected group of general practitioners indicated majority support for a traditional disease conception of alcoholism embodying abstinence as the goal of treatment. Separate attitudinal factors which emerged represented a modified disease conception, a moralistic attitude and a belief in a drinking-problem continuum. The general practitioners' attitude structure was significantly related with their practice and belief in the efficacy of giving advice to patients with alcohol-related problems.     

Access by general practitioners to physiotherapy department of a district general hospital.

There has been much opposition, voiced most notably in the Tunbridge Report, to general-practitioner access to hospital rehabilitation services. Co-operation between general practitioners, physiotherapists, and the consultant with responsibility for the physiotherapy department at a general district hospital has provided an efficient open-access service. This service has been welcomed by the general practitioners because it supplies prompt treatment for their patients and by the physiotherapists because it enables them to minimise disability by treating musculoskeletal problems at an early stage.