Rethinking the professional spirit of family doctors in integrated medical and elderly care services in mountainous areas under the digital intelligence era
-
摘要:
目的 探究数智化时代下山区医养结合服务现状与家庭医生的职业困境，为其更好地践行职业精神提供对策。 方法 对北京市怀柔区北部山区已开通“综合远程诊疗模式”服务的5个乡镇开展研究。对217名老年居民进行问卷调查，了解其医疗与养老情况；对5家社区卫生服务中心医务人员进行问卷调查与访谈，了解医养结合服务提供情况及山区家庭医生面临的职业困境；对琉璃庙镇社区卫生服务中心“综合远程诊疗服务”进行典型案例分析。 结果 山区老年居民以居家养老为主，多数与配偶同居(178名，82.03%)，慢性病患病率较高(138名，63.59%)，对乡村医生信任度更高(116名，53.46%)；家庭医生及其团队人员对数智化技术了解程度较高，工作中主要面临交通不便、与患者沟通不畅等问题，并普遍认为这些问题会对工作造成负面影响；大部分家庭医生及其团队人员认为数智化技术对其工作效率(60名，76.92%)及质量(59名，75.64%)有积极影响。 结论 在数智化背景下，山区家庭医生在提供医养结合服务时主要面临工作效率较低、服务范围延伸、上门服务风险较高、医患沟通困难等职业困境。可通过利用智慧医疗技术、推动适老化环境改造、完善基层医疗服务制度、构建医患沟通渠道等措施进行解决。 Abstract:Objective To investigate integrated elderly care services in mountainous regions and the professional challenges faced by family doctors in the digital intelligence era, with a view to proposing improvement strategies. Methods A study was conducted in five townships in the northern Huairou Districtof Beijing, with the implementation of the "Comprehensive Remote Diagnosis and Treatment Model". Surveys were administered to 217 elderly residents and five community health centers, combined with interviews and case analysis of Liulimiao Community Health Center ' s remote services. Results The majority of elderly residents expressed a preference for home-based care (178 cases, 82.03% of whom resided with their spouses), with a 63.59% prevalence of chronic diseases (138 cases) and a higher level of trust in rural doctors (116 cases, 53.46%). While family doctors demonstrated proficiency in digital technologies, they encountered challenges such as inadequate transportation and communication infrastructure, which they anticipated would have a detrimental effect on professional activities. The majority of family doctors and their team members believe that digital and intelligent technologies have a positive impact on their work efficiency (60 cases, 76.92%) and quality (59 cases, 75.64%). Conclusion Family doctors in mountainous areas encounter difficulties including low efficiency, expanded service scope, heightened risks associated with home visits, and communication barriers. The recommendations set out in the report include adopting smart medical technologies, improving elderly-adapted environments, refining primary care policies, and enhancing doctor-patient communication. -
表 1 老年居民基本情况
Table 1. The basic situation of elderly residents
项目 分类 人数(%) 性别 男性 110(50.69) 女性 107(49.31) 文化程度 文盲及半文盲 52(23.96) 小学 96(44.24) 初中 52(23.96) 高中及以上 17(7.83) 慢性疾病患病情况 未患病 79(36.41) 患有1种 89(41.01) 患有2种 33(15.21) 患有3种及以上 16(7.37) 居住情况 独居 17(7.83) 与配偶同住 178(82.03) 与子女同住 21(9.68) 与其他亲属同住 1(0.46) 
下载: 导出CSV
表 2 老年居民最近1年中自行前往医疗机构就诊的原因
Table 2. Reasons for seeking medical treatment among elderly residents who went to medical institutions on their own in the past year
就诊原因 人次 顺位 身体不适 189 1 慢性病定期复诊取药 134 2 抽血化验复查 109 3 中医及理疗项目 49 4 其他原因 14 5
下载: 导出CSV
表 3 家庭医生签约服务团队过去1年内为辖区内老年居民提供服务的内容及方式
Table 3. Contents and methods of services provided by community medical staff to elderly residents in their jurisdiction in the past year
项目 分类 人次 顺位 服务内容 老年人健康管理服务(老年人体检) 61 1 门诊服务 54 2 上门健康评估和上门健康服务 51 3 服务方式 机构内统一安排体检等 51 1 门诊预约 49 2 上门服务 41 3 门诊随机服务 33 4
下载: 导出CSV
表 4 家庭医生签约服务团队与老人及其家属沟通不畅的原因
Table 4. Reasons for poor communication between community medical staff and the elderly as well as their families
原因 人次 顺位 老年人听力下降 49 1 老年人健康意识不强，对沟通内容不重视 49 1 山区老年人文化水平不高，认知能力不强 40 3 与子女等照护者沟通后其没有及时将信息传递给老年人 31 4 照护者缺乏专业知识，不重视 24 5
下载: 导出CSV
-
[1] 国家卫生健康委, 民政部, 国家医保局, 等. 《关于促进医养结合服务高质量发展的指导意见》(国卫老龄发〔2024〕40号)[EB/OL]. (2024-12-12). https://www.gov.cn/zhengce/zhengceku/202412/content_6992253.htm .National Health Commission, Ministry of Civil Affairs, National Healthcare Security Administration, National Administration of Traditional Chinese Medicine, & National Disease Control and Prevention Administration. (2024). Guiding opinions on promoting the high-quality development of integrated medical and elderly care services (No. 40, 2024). [EB/OL]. (2024-12-12).https://www.gov.cn/zhengce/zhengceku/202412/content_6992253.htm .[2] 韦旭楠. 基于职业锚理论的医师职业精神影响因素研究[D]. 沈阳: 中国医科大学, 2024.WEI X N. Research on influencing factors of physicians ' professionalism based on career anchor theory[D]. Shenyang: China Medical University, 2024. [3] 冯春磊. 新中国医师职业精神的丰富与发展[J]. 中国医学人文, 2024, 10(6): 70-72.FENG C L. The enrichment and development of physicians ' professionalism in New China[J]. Chinese Medical Humanities, 2024, 10(6): 70-72. [4] 王琳琳, 刘艳萍, 梁闪, 等. 国外老年人居家照护研究的文献计量学分析[J]. 中国临床护理, 2024, 16(4): 238-242.WANG L, LIU Y P, LIANG S, et al. A bibliometric analysis of international research on home care for the elderly[J]. Chinese Journal of Clinical Nursing, 2024, 16(4): 238-242. [5] 葛立宾, 秦丽. 社区医务人员上门出诊服务的影响因素研究[J]. 中国社区医师, 2023, 39(31): 162-164.GE L B, QIN L. Research on influencing factors of home visit services by community healthcare workers[J]. Chinese Community Doctors, 2023, 39(31): 162-164. [6] 王睿, 韩此林, 曹渊卿, 等. 医师职业倦怠影响因素的多水平模型分析[J]. 昆明医科大学学报, 2024, 45(11): 67-72.WANG R, HAN C L, CAO Y Q, et al. Multilevel modeling analysis of factors influencing physician burnout[J]. Journal of Kunming Medical University, 2024, 45(11): 67-72. [7] 曹茹, 王锦帆. 基于扎根理论与核心文献的医患关系影响因素模型分析[J]. 中国卫生事业管理, 2021, 38(9): 664-667, 671.CAO R, WANG J F. Analysis of influencing factors model of doctor-patient relationship based on grounded theory and core literature[J]. Chinese Health Service Management, 2021, 38(9): 664-667, 671. [8] 徐僖, 车丹丹, 钱翠玉, 等. 医患沟通不良在医疗纠纷中的影响案例分析[J]. 现代医药卫生, 2021, 37(4): 714-716.XU X, CHE D D, QIAN C Y, et al. Case analysis of the impact of poor doctor-patient communication in medical disputes[J]. Journal of Modern Medicine & Health, 2021, 37(4): 714-716. [9] 陈静静, 王海利, 彭迎春. 镇村卫生一体化管理下京郊村卫生室服务现状及发展对策探究[J]. 中华全科医学, 2024, 22(2): 277-280. doi: 10.16766/j.cnki.issn.1674-4152.003383CHEN J J, WANG H L, PENG Y C. Research on service status and development strategies of village clinics in Beijing suburbs under integrated township-village health management[J]. Chinese Journal of General Practice, 2024, 22(2): 277-280. doi: 10.16766/j.cnki.issn.1674-4152.003383 [10] 江泽慧, 胡文琪, 钟嘉雯, 等. 智慧医疗在社区智慧养老中存在的问题与对策研究[J]. 中国医院, 2024, 28(11): 74-76.JIANG Z H, HU W Q, ZHONG J W, et al. Research on problems and countermeasures of smart healthcare in community-based smart elderly care[J]. Chinese Hospitals, 2024, 28(11): 74-76. [11] 张霞, 杨永学, 王凌霄, 等. 重度失能老年人移动辅助器具掌握情况现状及其影响因素分析[J]. 广西医学, 2023, 45(18): 2244-2248, 2255.ZHANG X, YANG Y X, WANG L X, et al. Current status and influencing factors of mobility assistive device utilization among severely disabled elderly[J]. Guangxi Medical Journal, 2023, 45(18): 2244-2248, 2255. [12] 倪晨旭, 邵宝魁, 丛正龙, 等. 社区适老化改造对老年人健康的影响[J]. 中国人口科学, 2024, 38(5): 113-128.NI C X, SHAO B K, CONG Z L, et al. The impact of community aging-adapted renovations on elderly health[J]. Chinese Journal of Population Science, 2024, 38(5): 113-128. [13] 陈旻洁, 沈璐, 樊翊凌, 等. 基于医务人员视角的"互联网+"上门医疗服务风险分析及对策[J]. 中国卫生质量管理, 2023, 30(9): 54-57.CHEN M J, SHEN L, FAN Y L, et al. Risk analysis and countermeasures of "Internet+" home medical services from medical staff ' s perspective[J]. Chinese Journal of Health Quality Management, 2023, 30(9): 54-57. [14] 彭迎春, 段雪溪. 医患双向视角下"互联网+"医患关系认知差异及改进径路探析[J]. 中国医学伦理学, 2023, 36(9): 1022-1029.PENG Y C, DUAN X X. Analysis of cognitive differences and improvement pathways in "Internet+" doctor-patient relationships from dual perspectives[J]. Chinese Medical Ethics, 2023, 36(9): 1022-1029. [15] 张如意, 彭迎春, 张志颖. "村医社医联动"签约模式在京北山区老年居民中的应用效果及对策研究[J]. 中国全科医学, 2022, 25(4): 445-452.ZHANG R Y, PENG Y C, ZHANG Z Y. Effectiveness and improvement strategies of the "village-community physician collaboration" contract model for elderly residents in northern Beijing mountainous areas[J]. Chinese General Practice, 2022, 25(4): 445-452. [16] 尹秀云. 医师职业精神的历史演变[J]. 医学与哲学, 2023, 44(24): 8-13.YIN X Y. The historical evolution of medical professionalism[J]. Medicine & Philosophy, 2023, 44(24): 8-13. -
点击查看大图
表(4)
计量
- 文章访问数: 16
- HTML全文浏览量: 8
- PDF下载量: 1
- 被引次数: 0
