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中国大陆基层医疗卫生机构新冠疫情防控管理团队的任务:一项全国性在线横断面调查。

Tasks of COVID-19 prevention and control management teams at primary health care facilities in mainland China: a nationwide online cross-sectional survey.

机构信息

Department of General Practice, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China.

Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.

出版信息

BMC Prim Care. 2022 May 6;23(1):110. doi: 10.1186/s12875-022-01703-0.

Abstract

BACKGROUND

This research aimed to investigate the tasks performed by Coronavirus Disease 2019(COVID-19) prevention and control management teams at primary healthcare (PHC) facilities during COVID-19 pandemic across the mainland China.

METHODS

An online survey was performed and COVID-19 prevention and control management teams at PHC facilities were invited to participate in this research. The top 7 most important tasks in the three different periods of COVID-19 containment were selected and ranked. Participations of tasks were surveyed.

RESULTS

A total of 998 valid responses (an effective rate of 99.11%) were collected. The respondents were divided into Group A (≤5 respondents within each PHC facility, n = 718) and Group B (> 5 respondents within each PHC facility, n = 280). The consensus was selected from top 7 most important tasks including screening at travel centers/intervals and screening at entry centers, at-home/centralized quarantine management, transferring, pre-examination/triage and fever sentinel surveillance clinic/fever clinic. Pre-examination/triage and fever sentinel surveillance clinic/fever clinic works became more significant in the regular prevention and control period. Adjusted analysis found that team members of Group A with a college, undergraduate college and graduate school educational background were less involved in pre-examination/triage works (aOR: 0.28; 95%CI: 0.09-0.86, P = 0.026; aOR: 0.30; 95%CI: 0.10-0.90, P = 0.031; aOR: 0.21; 95%CI: 0.05-0.82, P = 0.024). Those who were over the median age were twice more likely to be engaged in managing fever sentinel surveillance of clinic/fever clinic visitors (aOR: 2.18; 95%CI: 1.16-4.08, P = 0.015). Those being specialized in nursing and other specialties were less likely to participate in fever sentinel surveillance of clinic/fever clinic works (aOR: 0.44; 95%CI: 0.24-0.81, P = 0.009; aOR: 0.30; 95%CI: 0.16-0.58, P < 0.001). Those came from central and western China were less likely to participate in centralized quarantine management (aOR: 0.61; 95%CI: 0.38-0.98, P = 0.042; aOR: 0.64; 95%CI: 0.42-0.97, P = 0.037). Team members came from central and western China were twice less likely to participate in screening at travel centers/intervals (aOR: 1.75; 95%CI: 1.14-2.70, P = 0.011; aOR: 1.63; 95%CI: 1.07-2.48, P = 0.024).

CONCLUSION

In mainland China, team members of COVID-19 prevention and control at PHC facilities are mainly responsible for screening, quarantine, transferring and monitoring during the COVID-19 pandemic. Pre-examination/triage and the fever sentinel surveillance clinic/fever clinic were gradually valued. Team members with lower educational background are competent in pre-examination/triage works, but more experienced general practitioners are more likely to be in charge of fever sentinel surveillance clinic/fever clinics work. The necessity of COVID-19 prevention and control management teams to participate in screening at travel centers/intervals is subjected to further discussions.

摘要

背景

本研究旨在调查中国大陆新冠肺炎疫情期间基层医疗卫生机构(PHC)新冠疫情防控管理团队所承担的任务。

方法

采用在线调查的方式,邀请 PHC 机构的新冠疫情防控管理团队参与研究。选取并排名了三个不同时期疫情防控中最重要的前 7 项任务。调查了参与任务的情况。

结果

共收集到 998 份有效回复(有效率为 99.11%)。受访者分为 A 组(每个 PHC 机构内回复人数≤5 人,n=718)和 B 组(每个 PHC 机构内回复人数>5 人,n=280)。从最重要的 7 项任务中选择了共识,包括旅行中心/间隔筛查和入口中心筛查、居家/集中隔离管理、转诊、预检/分诊和发热哨点监测诊所/发热诊所。预检/分诊和发热哨点监测诊所/发热诊所工作在常规防控期间变得更加重要。调整分析发现,A 组中具有大专、本科和研究生学历的团队成员较少参与预检/分诊工作(调整后的比值比:0.28;95%置信区间:0.09-0.86,P=0.026;调整后的比值比:0.30;95%置信区间:0.10-0.90,P=0.031;调整后的比值比:0.21;95%置信区间:0.05-0.82,P=0.024)。年龄超过中位数的团队成员更有可能负责管理发热哨点监测诊所/发热诊所就诊者的发热情况(调整后的比值比:2.18;95%置信区间:1.16-4.08,P=0.015)。从事护理和其他专业的团队成员更不可能参与发热哨点监测诊所/发热诊所工作(调整后的比值比:0.44;95%置信区间:0.24-0.81,P=0.009;调整后的比值比:0.30;95%置信区间:0.16-0.58,P<0.001)。来自中国中西部地区的团队成员更不可能参与集中隔离管理(调整后的比值比:0.61;95%置信区间:0.38-0.98,P=0.042;调整后的比值比:0.64;95%置信区间:0.42-0.97,P=0.037)。来自中国中西部地区的团队成员参与旅行中心/间隔筛查的可能性低至一半(调整后的比值比:1.75;95%置信区间:1.14-2.70,P=0.011;调整后的比值比:1.63;95%置信区间:1.07-2.48,P=0.024)。

结论

在中国内地,PHC 机构新冠疫情防控管理团队的主要职责是在疫情期间进行筛查、隔离、转诊和监测。预检/分诊和发热哨点监测诊所/发热诊所逐渐受到重视。教育程度较低的团队成员有能力进行预检/分诊工作,但经验更丰富的全科医生更有可能负责发热哨点监测诊所/发热诊所工作。新冠疫情防控管理团队参与旅行中心/间隔筛查的必要性需要进一步讨论。

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