摘要
背景大力培养全科医生和提升以全科医生为核心的基层医疗卫生队伍执业能力是我国基层卫生人力资源发展的重要方向。目前,我国缺乏适用于基层执业环境测评全科医生临床能力的指标体系,阻碍了准确鉴定全科医生临床能力缺口,不利于持续改善全科医生及基层医疗卫生队伍的教育培训工作。目的基于经典列斯特评估量表(LAP)构建适用于我国基层医疗执业环境的全科医生应诊能力评价指标体系,为客观评价基层全科医生临床能力提供指标模型参考。方法于2022年5—8月,采用目的抽样法,邀请15名专家以函询的方式实施德尔菲法,评价初始基层全科医生应诊能力评价指标体系中各指标的重要性、可行性等。运用层次分析法计算指标体系中各一级指标和二级指标的权重及组合权重。结果共计实施2轮专家咨询,专家积极系数、熟悉程度、判断系数、权威系数在两轮咨询中均为100%、0.77、0.91、0.84;各指标重要性及可行性评分均数均>3.5分,变异系数均<0.3,两轮咨询中指标重要性及可行性的专家肯德尔系数均有统计学意义(P<0.001),且第2轮高于第1轮;专家咨询共计提出10条新增指标类意见、1条合并指标类意见、29条修改指标表述类意见。经两轮德尔菲法修订,最终构建的指标体系共计含7个一级指标和42个二级指标。指标体系中,7个一级指标的权重为13.61%~14.69%,二级指标的组合权重为0.95%~4.91%。结论本研究基于经典LAP,构建了适用于我国基层医疗环境的全科医生应诊能力评价指标体系。指标体系包括7个一级指标和42个二级指标,内容覆盖全科医生应诊工作的各主要环节和重点任务,具备较高的科学性和实用性。
Background Training general practitioners(GPs)and improving the practice competence of"GPcentered"primary health care personnel are important directions of the development of human resources for primary health care in China.At present,there is lack of an index system applicable to evaluate clinical competence of GPs in the circumstances of primary health care in China,which not only hampers accurate identification of gaps in clinical competence of GPs,but also impedes sustainable improvement of the education and training of GPs as well as primary health care personnel.Objective To develop an evaluation index system for consultation competency of GPs in the circumstances of primary health care in China based on the original version of Leicester Assessment Package(LAP),so as to provide an index model reference for the objective evaluation of consultation competency of GPs.Methods Between May to August in 2022,a total of 15 experts were invited by using the purposive sampling method to implement the Delphi method by correspondence,to evaluate the importance,feasibility,and textual representation of each index in the initial evaluation index system for consultation competency of GPs.Analytic hierarchy process was adopted to calculate weight and combined weight for the first-level and secondary-level indexes.Results A total of two rounds of Delphi were conducted.The positivity coefficient,familiarity level,judgment coefficient,and authority coefficient were 100%,0.77,0.91,and 0.84 in both rounds of consultation;the mean score of the importance and feasibility of each indicator was 3.5,and the variation coefficient was 0.3.The Kendall coefficients for the importance and feasibility of the indexes in the two rounds of consultation were statistically different(P<0.001)and higher in the second round than in the first round.A total of 10 comments recommended to increase indexes,one comment to combine indexes,and 29 comments to modify indexes were collected during two rounds of Delphi consultation.The final version of evaluation system consisted of 7 first-level indexes and 42 second-level indexes,the weights of the 7 primary indicators ranged from 13.61%to 14.69%,and the combined weights of the secondary indicators ranged from 0.95%to 4.91%.Conclusion This study has constructed an evaluation index system for consultation competency of GPs in the circumstances of primary health care in China based on the original version of LAP.The evaluation index system includes 7 first-level indexes and 42 second-level indexes,which covers each essential section and important missions in GP consultations with high scientificity and practicality.
作者
顾劲梅
覃丽
赵璨
彭厚瑄
奚谦
申颖
GU Jingmei;QIN Li;ZHAO Can;PENG Houxuan;XI Qian;SHEN Ying(Department of General Practice,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Tanluo Central Township Health Center,Xixiangtang District,Nanning 530041,China;Zhoulu Central Township Health Center,Mashan County,Nanning 530603,China;Yanan Township Health Center,Jiangnan District,Nanning 530229,China;School of General Practice,Guangxi Medical University,Nanning 530021,China)
出处
《中国全科医学》
北大核心
2024年第4期468-475,共8页
Chinese General Practice
基金
广西自然科学基金资助项目(2020GXNSFAA238019)。
关键词
全科医生
应诊能力
层次分析法
评价指标体系
列斯特评估量表
General practitioners
Consultation competency
Analytic hierarchy process
Assessment system
Leicester assessment package
