提高全科医生的心身医学技能：来自生态系统理论的见解。

Enhancing Psychosomatic Medicine Skills in General Practitioners: Insights from Ecological Systems Theory.

作者信息

Zeng Zixuan, Qian Yingli, Zhang Wei, Hu Jia, Jiang Jiahui, Zeng Lianhua, Chen You, Huang Lei

机构信息

School of Medicine, Tongji University, Shanghai, 200331, People's Republic of China.

Department of Psychiatry, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China.

出版信息

Int J Gen Med. 2025 Sep 17;18:5591-5603. doi: 10.2147/IJGM.S527054. eCollection 2025.

DOI:10.2147/IJGM.S527054

PMID:40984974

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12450380/

Abstract

PURPOSE

Based on the Ecological Systems Theory, this study aims to identify multilevel factors that influence the psychosomatic medical service competency (PMSC) of general practitioners (GPs).

METHODS

A cross-sectional survey was conducted among 699 community general practitioners in Shanghai from December 2022 to March 2023 using a stratified random cluster sampling method. GPs' PMSC was assessed using a validated 27-item scale, covering knowledge, attitude and skills dimensions, with additional self-evaluative measures on perceived competency and training needs. Based on ecological systems theory, individual, institutional and systemic factors were examined. A three-stage hierarchical regression analysis was performed to identify multilevel determinants of PMSC.

RESULTS

A total of 713 questionnaires were distributed, yielding 699 valid responses. The response rate was 98.04%. According to the multiple hierarchical regression analysis, higher educational attainment ( < 0.05) and greater empathy ( = 0.256, < 0.001) were significantly associated with higher PMSC, explaining 7% of the variance (² = 0.07, < 0.001). While institutional factors (including psychological services, medication availability and referral pathways) were associated with PMSC in bivariable analysis ( < 0.01), they were not significant in multivariable models. PMSC training emerged as the strongest predictor of PMSC (² = 0.263, < 0.001), emphasizing its critical role in competency development.

CONCLUSION

Educational attainment, empathy, and training significantly influence general practitioners' psychosomatic medical service competency, with training coverage being the strongest predictor. This study highlighted the urgent need for targeted training and policy reforms to enhance psychosomatic care in Chinese primary care settings.

摘要

目的

基于生态系统理论，本研究旨在确定影响全科医生心身医学服务能力（PMSC）的多层次因素。

方法

2022年12月至2023年3月，采用分层随机整群抽样方法，对上海699名社区全科医生进行了横断面调查。使用经过验证的27项量表评估全科医生的PMSC，该量表涵盖知识、态度和技能维度，并对感知能力和培训需求进行了额外的自我评估。基于生态系统理论，对个体、机构和系统因素进行了研究。进行了三阶段分层回归分析，以确定PMSC的多层次决定因素。

结果

共发放问卷713份，有效问卷699份。有效率为98.04%。根据多元分层回归分析，较高的教育程度（<0.05）和更强的同理心（=0.256，<0.001）与较高的PMSC显著相关，解释了7%的方差（²=0.07，<0.001）。虽然在双变量分析中，机构因素（包括心理服务、药物供应和转诊途径）与PMSC相关（<0.01），但在多变量模型中并不显著。PMSC培训成为PMSC最强的预测因素（²=0.263，<0.001），强调了其在能力发展中的关键作用。