Liu Yanli, Chen Chao, Jin Guanghui, Zhao Yali, Chen Lifen, Du Juan, Lu Xiaoqin
Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China.
Department of Education, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.
PLoS One. 2017 Dec 21;12(12):e0190036. doi: 10.1371/journal.pone.0190036. eCollection 2017.
The purpose of this study was to describe the patients' reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training.
This study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients' RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics.
A total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p<0.001). Patients who had visited the CHSC previously and signed contracts with the GP team had more health problems than those who had not (p<0.001).
These findings present a view of patients' demands and work contents of GPs in Beijing rural areas and can provide reference for health services planning and GPs training.
本研究旨在描述北京农村地区患者的就诊原因（RFE）以及全科医生（GP）处理的健康问题，为卫生服务规划和全科医生培训提供依据。
本研究采用多阶段抽样方法，在北京6个郊区的14个社区卫生服务中心（CHSC）开展。从研究地点共选取了100名全科医生。基于主观-客观-评估-计划（SOAP）设计了一份自填式数据收集表，包括患者特征、就诊原因、健康问题、干预措施和咨询时长。每位全科医生使用国际初级保健分类第2版（ICPC-2）对其连续100例患者的就诊原因和健康问题进行记录和编码。采用描述性统计描述就诊原因和健康问题的分布情况。运用学生t检验和方差分析比较不同患者特征每次就诊的平均就诊原因数量或健康问题数量的差异。
共记录了10000次患者就诊，涉及13705个就诊原因和15460个健康问题。就诊原因和健康问题主要分布在呼吸、循环、肌肉骨骼、内分泌、代谢和营养以及消化系统。咳嗽和高血压分别是最常见的就诊原因和健康问题。随着年龄的增加，平均就诊原因数量减少，平均健康问题数量增加。拥有北京医疗保险的患者比其他城市的患者就诊原因更少，但健康问题更多（p<0.001）。之前到过社区卫生服务中心并与全科医生团队签约的患者比未签约的患者健康问题更多（p<0.001）。
这些发现呈现了北京农村地区患者的需求以及全科医生的工作内容，可为卫生服务规划和全科医生培训提供参考。
