上海市社区全科医生对帕金森病的诊断认知及影响因素分析

赵亚军; 田久鹏; 王德强; 张房艳; 杨森; 葛许华

doi:10.16766/j.cnki.issn.1674-4152.002460

上海市社区全科医生对帕金森病的诊断认知及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002460

赵亚军^{1, 2},
田久鹏^{1, 2},
王德强^{1, 2},
张房艳³,
杨森^{1, 2},
葛许华^{1, 2, 4, ,}

1.
同济大学附属杨浦医院全科医学科，上海 200090
2.
同济大学医学院全科医学系，上海 200090
3.
上海市普陀区人民医院全科医学科，上海 200060
4.
上海市全科医学与社区卫生发展研究中心，上海 200090

基金项目:

上海市医药卫生发展基金会课题 SE1201933

上海市青年科技英才扬帆计划 20YF1444900

2021年同济大学研究生教育研究与改革医学专项教育管理专项项目 2021YXGL14

详细信息

通讯作者:
葛许华，E-mail：gexuhuaxzyy@aliyun.com

中图分类号: R197.61 R742.5
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- 被引次数: 0
出版历程
- 收稿日期: 2021-10-30
- 网络出版日期: 2022-09-05

Diagnosis cognition and influencing factors of Parkinson disease among community general practitioners in Shanghai

ZHAO Ya-jun^{1, 2},
TIAN Jiu-peng^{1, 2},
WANG De-qiang^{1, 2},
ZHANG Fang-yan³,
YANG Sen^{1, 2},
GE Xu-hua^{1, 2, 4
, ,}

1.
Department of General Practice, Yangpu Hospital, Tongji University, Shanghai 200090, China

摘要

摘要: 目的了解上海市社区全科医生对帕金森病的诊断认知并对其影响因素进行分析，为提高全科医生在社区早期识别帕金森病的意识和能力提供可参考依据。方法 2020年9月25日—10月28日选择上海市553名社区全科医生作为研究对象，采用自行设计的调查表对其进行电子问卷调查。采用χ²检验和Mann-Whitney U检验对不同认知水平的全科医生特征进行比较，采用多因素logistic回归分析探讨其影响因素。结果仅38.1%(210/551)的全科医生认为在社区可以诊断帕金森病，61.9%(341/551)的全科医生认为不可以；原因前3位分别为对帕金森病的运动及非运动症状掌握不足(60.4%，206/341)、帕金森病需要专门的设备才能诊断(49.6%，169/341)、缺乏专业背景，不能理解或看不懂指南(46.0%，157/341)。影响因素有职称(OR=1.555，95% CI为1.160~2.086，P < 0.05)、有无了解过相关诊疗指南(OR=3.167，95% CI为2.186~4.589，P < 0.05)、有无神经内科专家门诊(OR=1.702，95% CI为1.127~2.571，P < 0.05)。结论社区全科医生对帕金森病的诊断认知存在不足，早期识别帕金森病的意识和能力有待提高，影响因素包括职称、有无了解过相关诊疗指南和有无神经内科专家门诊，社区卫生服务中心可以通过设立神经内科专家门诊，以门诊带教的形式并结合全科医生的需求内容进行干预，以期提高社区居民帕金森病的早期诊断率。
- 全科医生 /
- 帕金森病 /
- 诊断 /
- 影响因素
Abstract: Objective To investigate the diagnosis cognition of Shanghai community general practitioners on Parkinson disease and analyze its influencing factors, in order to provide a reference for improving the awareness and ability of general practitioners in early recognition of Parkinson disease. Methods The questionnaire survey method was used from September 25 to October 28, 2020. A total of 553 community general practitioners in Shanghai were selected as the research objects, and the self-designed questionnaire was used to conduct an electronic questionnaire survey. The χ² test and Mann-Whitney U test were used to compare the characteristics of general practitioners at different levels of cognition, and the multi-factor logistics regression method was used to explore the influencing factors. Results Only 38.1% (210/551) of general practitioners believed that Parkinson disease could be diagnosed in the community, and 61.9% (341/551) of them believed that it was not possible. The top three reasons were as follows: 60.4% (206/341) of the motor and non-motor symptoms of Parkinson disease were not mastered; 49.6% (169/341) of Parkinson disease needed special equipment to diagnose; 46.0% (157/341) of them could not understand the Parkinson disease guidelines due to lack of professional background. The influencing factors were professional title (OR=1.555, 95% CI: 1.160-2.086, P < 0.05), whether they knew the relevant diagnosis and treatment guidelines (OR=3.167, 95% CI: 2.186-4.589, P < 0.05), and whether there was neurology specialist clinic (OR=1.702, 95% CI: 1.127-2.571, P < 0.05). Conclusion General practitioners ' cognition of the diagnosis of Parkinson disease is obviously insufficient. The awareness and ability of early recognition of Parkinson disease needs to be improved. The influencing factors include professional title, whether they know the relevant diagnosis and treatment guidelines, and whether there is neurology specialist clinic. The community health service centers can establish neurology specialist clinics, and give priority to the intervention in the form of outpatient teaching combined with the needs of general practitioners, in the hope of improving the early diagnosis rate of Parkinson disease among community residents.
- General practitioners /
- Parkinson disease /
- Diagnosis /
- Influencing factors

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表 1 社区全科医生对PD诊断认知情况的单因素分析[例(%)]

Table 1. Univariate analysis of cognition of PD diagnosis among community general practitioners[cases (%)]

项目	类别	全科医生在社区可否诊断PD		统计量	P值
项目	类别	可以(n=210)	不可以(n=341)	统计量	P值
性别	男性	72(34.3)	94(27.6)	2.788^a	0.095
	女性	138(65.7)	247(72.4)
学历	本科	158(75.2)	258(75.7)	0.013^a	0.911
	硕士及以上	52(24.8)	83(24.3)
职称	住院医师	68(32.4)	68(19.9)	-1.897^b	0.058
	主治医师	105(50.0)	222(65.1)
	高级职称	37(17.6)	51(15.0)
工作年限(年)	＜5	51(24.3)	58(17.0)	-1.618^b	0.106
	5~10	59(28.1)	104(30.5)
	＞10	100(47.6)	179(52.5)
工作单位区域	市区	91(43.3)	159(46.6)	0.569^a	0.451
	郊区	119(56.7)	182(53.4)
了解过相关诊疗指南	有	129(61.4)	116(34.0)	39.545^a	< 0.001
	无	81(38.6)	225(66.0)
神经内科专家门诊	有	67(31.9)	69(20.2)	9.521^a	0.002
	无	143(68.1)	272(79.8)
注：^a为χ²值，^b为Z值。

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表 2 全科医生对PD诊断认知情况的logistic回归分析

Table 2. Logistic regression analysis of general practitioners ' cognition of PD diagnosis

项目	B	SE	Wald χ²	P值	OR值	95% CI
性别	0.219	0.199	1.206	0.272	1.245	0.842~1.840
职称	0.442	0.150	8.695	0.003	1.555	1.160~2.086
了解过相关诊疗指南	1.153	0.189	37.113	< 0.001	3.167	2.186~4.589
神经内科专家门诊	0.532	0.210	6.389	0.011	1.702	1.127~2.571

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