Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Shenzhen, China.
BMJ Open. 2020 Feb 3;10(2):e036240. doi: 10.1136/bmjopen-2019-036240.
Since 2011 China's central government has committed to establishing a new 'general practitioner' (GP)-centred primary care system. To this end there have been great efforts to train an additional 300 000 GPs by 2020. This paper examines the perspective of practitioners in Henan, China, regarding general practice.
A mixed-methods approach using focus group discussions (FGD), and structured questionnaires.
SETTING/PARTICIPANTS: Seven FGDs and responses to 1887 questionnaires included medical students, primary care doctors and GP residents in Henan.
The three surveyed medical groups have some awareness of the attributes of general practice (eg, comprehensiveness, first contact and coordination), but often misinterpret what being a GP entails. Five themes were identified through the FGDs and tested quantitatively for their prevalence with structured questionnaires. First, the GPs' role as a comprehensive care provider was (mis)interpreted as an 'all-round doctor'. Second, the GP's responsibility as the first point of care was understood in two conflicting ways: private personal doctors of the rich and the powerful or village doctors for common people. Third, referral was understood as simply guiding patients to appropriate departments within the hospital while the gatekeeping role was interpreted to involve GPs being peoples' health protectors rather than being also gatekeepers of specialty services. Traditional Chinese medicine now further complicates the understanding of GPs. And lastly, the GPs' main responsibility was considered to be public health work.
The misunderstandings of the roles and responsibilities of GPs render problematic the policy foundation of China's GP-centred primary care system. Pursuing the quantity of GPs on its own is meaningless, since the number needed depends on the delineated role of GPs. Top priority is to establish clarity about the GP role, which requires reforming the health delivery system to address issues with fragmented care, strategically taking into account the development of GPs with work delegation and substitution and providing more clarity on the distinction between general practice and public health.
自 2011 年以来，中国中央政府致力于建立新的以“全科医生”为中心的基层医疗体系。为此，中国政府计划到 2020 年培训 30 万名全科医生。本文从中国河南省从业者的角度探讨了全科医学。
采用焦点小组讨论（FGD）和结构问卷调查的混合方法。
地点/参与者：在河南，有 7 个焦点小组讨论和 1887 份问卷，包括医学生、基层医疗医生和全科医生住院医师。
三个被调查的医疗群体对全科医学的属性（如综合性、首诊和协调性）有一定的认识，但往往对全科医生的职责有错误的理解。通过 FGD 确定了五个主题，并通过结构问卷对其普遍性进行了定量测试。首先，全科医生作为全面医疗服务提供者的角色被（错误）解释为“全能医生”。其次，全科医生作为首诊医生的责任有两种相互冲突的理解：为富人和权贵提供私人私人医生，或为普通人提供乡村医生。第三，转诊被理解为简单地指导患者到医院内的合适科室，而把关作用被解释为全科医生既要保护人们的健康，也要把关专科服务。现在，中医进一步使全科医生的理解复杂化。最后，全科医生的主要职责被认为是公共卫生工作。
对全科医生角色和职责的误解，使得中国以全科医生为中心的基层医疗体系的政策基础存在问题。单纯追求全科医生的数量是没有意义的，因为所需的数量取决于全科医生的明确角色。当务之急是明确全科医生的角色，这需要改革卫生服务提供系统，解决碎片化护理问题，从战略上考虑通过工作分工和替代来发展全科医生，并更清楚地区分全科医学和公共卫生。
