北京5家社区卫生服务机构全科医生进行的体格检查：一项观察性研究。

Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study.

作者信息

Wei Yun, Wang Feiyue, Pan Zhaolu, Wang Meirong, Jin Guanghui, Lu Xiaoqin

机构信息

Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You'anmenwai, Fengtai District, Beijing, 100069, China.

出版信息

BMC Prim Care. 2022 Jan 14;23(1):7. doi: 10.1186/s12875-021-01619-1.

DOI:10.1186/s12875-021-01619-1

PMID:35172736

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8759261/

Abstract

BACKGROUND

Physical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners' performance of physical examinations in consultations.

METHODS

An observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations.

RESULTS

A total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in "Head, face, and neck examination" (n = 54, 42.9%) and "Cardiovascular examination" (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation.

CONCLUSION

Physical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care.

摘要

背景

体格检查是会诊的核心组成部分。对于中国社区卫生服务机构中全科医生进行体格检查的现状了解甚少。本研究旨在调查全科医生在会诊中进行体格检查的情况。

方法

2019年11月至2020年1月间，在北京的5家社区卫生服务机构开展了一项观察性研究。对11名全科医生进行了一个工作日的观察。记录连续会诊的信息，包括患者特征、就诊原因、全科医生进行的体格检查、会诊时间长度以及会诊中在特定活动上花费的时间。

结果

共记录了11名全科医生的682次会诊。其中126次会诊（15.8%）进行了体格检查。有症状前来就诊的患者更有可能接受体格检查（P<0.001）。126次体格检查中，大部分分布在“头、面、颈部检查”（n=54，42.9%）和“心血管检查”（n=55，43.7%）。未对皮肤、男性生殖器、女性乳房和生殖器以及神经系统进行体格检查。共观察并记录了2823分钟的活动。全科医生在体格检查上仅花费了记录时间的3.1%，这低于用于问诊（18.2%）、检查（4.9%）、诊断（22.7%）、治疗（38.4%）和健康教育（8.6%）的时间。每次会诊平均花费在体格检查上的时间为0.8±0.4分钟。