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Article(id=1324077975259447748, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509265, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1757952000000, receivedDateStr=2025-09-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614389480, onlineDateStr=2026-11-02, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614389480, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614389480, creator=13701087609, updateTime=1793614389480, updator=13701087609, issue=Issue{id=1324077868950631142, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614364134, creator='13701087609', updateTime=1793614446224, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078213328142371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078213332336676, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=688, endPage=693, ext={EN=ArticleExt(id=1324077975498523077, articleId=1324077975259447748, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The construction of prescription management mechanism for public health physicians from a multi-group perspective: An empirical survey based on Sichuan Province, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the attitudes of different groups towards the construction of a mechanism for managing the prescription rights of public health physicians in Sichuan Province, with the goal of offering references for policy-making.

Methods

Through questionnaires combined with in-depth expert interviews, relevant staff from CDCs, general hospitals, health administrative departments, primary healthcare institutions at various levels in Sichuan Province, and scientific research institutions were surveyed towards the process and management mechanism of granting prescription rights to public health physicians.

Results

The respondents supported granting prescription rights directly to public health physicians who passed the third level hospital training (94.43%) or obtained a physician qualification certificate (93.73%). There were significant differences in the perception of prescription approval departments among different groups. Public health physicians (33.93%) and medical school teachers (42.47%) tended to favor provincial health administrative department approval and empowerment, while clinical physicians (33.74%), health administrative personnel (31.25%), and patients (35.08%) were more supportive of physician practice institution approval and empowerment. In terms of operational mechanism, the survey respondents supported the supervision and management of public health physicians’ prescription rights by county (district) health administrative departments (39.16%), and conduct regular assessments every two years (60.14%).

Conclusion

The granting of prescription rights to public health physicians should be steadily promoted at different levels, institutions, and departments. It is suggested to establish a hierarchical training path and differentiated assessment standards, as well as a dual-track regulatory system of "provincial coordination institutional execution". At the same time, promote legal rights confirmation and closed-loop management mechanisms to ensure the legal and compliant use of prescription rights by public health physicians.

, authors=Hong-yi SONG, Ke-yao XIONG, Ying WANG, Qin WU, Tian TIAN, Ling-ling LIU, authorsList=Hong-yi SONG, Ke-yao XIONG, Ying WANG, Qin WU, Tian TIAN, Ling-ling LIU, authorCompany=null, correspAuthors=Ling-ling LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077976412881354, articleId=1324077975259447748, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=多群体视角下公共卫生医师处方权管理机制构建——基于四川省的实证调查, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

了解四川省不同社会群体对公共卫生医师处方权管理机制构建的态度，为政府制定实施公共卫生医师处方权相关政策提供决策建议。

方法

采用问卷调查法结合专家深入访谈法，调查四川省各级疾控机构、综合医院、卫生行政部门、基层医疗机构及科研院校不同层级和不同职能的关键人员对公共卫生医师处方权赋予流程和管理机制构建的态度。

结果

调查对象支持公共卫生医师到三级医院进修合格（94.43%）或取得医师资格证（93.73%）后直接授予处方权。不同群体对处方权审批部门的认知差异显著，公共卫生医师（33.93%）和医学院校教师（42.47%）倾向省级卫生行政部门审批赋权，临床医师（33.74%）、卫生行政人员（31.25%）及患者（35.08%）更支持医师执业机构审批赋权。运行机制方面，调查对象支持由县（区）卫生行政部门（39.16%）对公共卫生医师处方权监督管理，开展两年一次（60.14%）的定期考核。

结论

公共卫生医师处方权的赋予应分层级、分机构、分科室稳步推进。建议构建分层培训路径与差异化考核标准以及“省级统筹-机构执行”双轨制监管体系，同时推动法律确权和闭环管理机制，确保公共卫生医师处方权的合法合规使用。

, authors=宋虹漪, 熊柯尧, 王滢, 吴沁, 田添, 刘玲玲, authorsList=宋虹漪, 熊柯尧, 王滢, 吴沁, 田添, 刘玲玲, authorCompany=null, correspAuthors=刘玲玲, authorNote=

宋虹漪（1995—），女，硕士，医师，研究方向：流行病与卫生统计学

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刘玲玲，E-mail:
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Chongqing launches pilot project on public health physicians’ prescribing rights[N]. Health News, 2024-07-24. (In Chinese), articleTitle=Chongqing launches pilot project on public health physicians’ prescribing rights, refAbstract=null), Reference(id=1324077984637911575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[12], rfOrder=22, authorNames=衣晓峰, journalName=健康报, refType=null, unstructuredReference=衣晓峰．黑龙江启动公卫医师处方权试点[N]．健康报，2024-07-02．, articleTitle=黑龙江启动公卫医师处方权试点, refAbstract=null), Reference(id=1324077984709214744, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[12], rfOrder=23, authorNames=Yi XF, journalName=Health News, refType=null, unstructuredReference=Yi XF. 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(In Chinese), articleTitle=Notice on issuing the “Three-Year Action Plan for Enhancing Public Health Capacity in Chongqing (2023-2025)”, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077976672928203, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, xref=null, ext=[AuthorCompanyExt(id=1324077976689705420, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, companyId=1324077976672928203, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Sichuan Province Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324077976714871245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, companyId=1324077976672928203, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川省疾病预防控制中心，四川 成都 610041)])], figs=[ArticleFig(id=1324077979525054966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=EN, label=Fig.1, caption=Departments of granting prescription rights to public health physicians, figureFileSmall=6m8ivO9RLPRRYrKtciJYHw==, figureFileBig=X5RcH1bX5g3q/rpkgPgbxQ==, tableContent=null), ArticleFig(id=1324077979613135351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=CN, label=图1, caption=公共卫生医师处方权赋予部门, figureFileSmall=6m8ivO9RLPRRYrKtciJYHw==, figureFileBig=X5RcH1bX5g3q/rpkgPgbxQ==, tableContent=null), ArticleFig(id=1324077979839627768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=EN, label=Fig.2, caption=Supervision and management departments for prescription rights of public health physicians, figureFileSmall=j0cH44k02YF23akaQ91WLg==, figureFileBig=WAiHqzHnkzwHJx8CZKAZ2w==, tableContent=null), ArticleFig(id=1324077979927708153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=CN, label=图2, caption=公共卫生医师处方权监督管理部门, figureFileSmall=j0cH44k02YF23akaQ91WLg==, figureFileBig=WAiHqzHnkzwHJx8CZKAZ2w==, tableContent=null), ArticleFig(id=1324077980158394874, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=EN, label=Table 1, caption=

Ways of obtaining prescription rights for public health physicians

, figureFileSmall=null, figureFileBig=null, tableContent=
总计卫生行政人员临床医师公共卫生医师医学院校教师社会受众（患者）χ2P值
取得医师资格证后直接授予处方权1 599（93.73）346（94.02）470（95.53）401（89.51）68（93.15）314（96.62）34.72<0.001
规范化培训（两年期）合格后直接授予处方权1 564（91.68）345（93.75）464（94.31）372（83.04）67（91.78）316（97.23）87.15<0.001
全科医学培训（一年期）合格后直接授予处方权1 580（92.61）349（94.84）460（93.50）394（87.95）61（83.56）316（97.23）62.33<0.001
三级综合性医院进修合格后直接授予相应范围处方权1 611（94.43）345（93.75）469（95.33）411（91.74）66（90.41）320（98.46）25.41<0.001
), ArticleFig(id=1324077980351332860, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=CN, label=表1, caption=

公共卫生医师处方权获取方式

, figureFileSmall=null, figureFileBig=null, tableContent=
总计卫生行政人员临床医师公共卫生医师医学院校教师社会受众（患者）χ2P值
取得医师资格证后直接授予处方权1 599（93.73）346（94.02）470（95.53）401（89.51）68（93.15）314（96.62）34.72<0.001
规范化培训（两年期）合格后直接授予处方权1 564（91.68）345（93.75）464（94.31）372（83.04）67（91.78）316（97.23）87.15<0.001
全科医学培训（一年期）合格后直接授予处方权1 580（92.61）349（94.84）460（93.50）394（87.95）61（83.56）316（97.23）62.33<0.001
三级综合性医院进修合格后直接授予相应范围处方权1 611（94.43）345（93.75）469（95.33）411（91.74）66（90.41）320（98.46）25.41<0.001
), ArticleFig(id=1324077980451996157, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=EN, label=Table 2, caption=

Qualitative interview results of prescription authority management mechanism for public health physicians

, figureFileSmall=null, figureFileBig=null, tableContent=
主类目子类目/关键观点代表性观点（频数）
1. 处方权赋予和管理机构行政部门主导“卫健委和疾控局共同赋予”（1）、“各级卫生行政部门”（3）
沿用临床医师管理机构“现行中临床医师由哪个机构管理，公卫医师就由哪个机构管理”（2）
2. 处方权赋予流程关键环节申请-培训-考核“提出申请、临床培训、考核合格”（2）、“注册备案+定期培训考核”（2）
反对赋予处方权“基层公卫医师缺员，增加工作量且无实际利好”（2）、“处方权意义有限，是否值得推广需评估”（2）
3. 政策与机制障碍法律法规限制“《执业医师法》限制公卫医师执业范围”（2）
职责定位冲突“公卫医师职责是疾病预防，非个体治疗”（4）
绩效考核矛盾“处方工作量考核削弱指令性任务完成”（2）
4. 日常监管与审查机制技术化监管工具“建立处方审核系统、患者反馈机制、定期抽查”（2）
行政部门定期审查“本级行政部门定期审查”（2）、“卫健委、疾控局”或“各级卫生行政部门”（4）
机构内部监管“机构出台制度+专家组审核”（3）
5. 培训与考核内容临床与法律知识“医学基础理论、公共卫生法律法规、临床知识、药物使用方法”（3）
技能更新与继续教育“定期开展新技能培训、案例分享与警示教育”（4）
6. 政策效果评估与优化体系化评估框架“构建评估指标、选择方法、建立优化机制”（2）
试点评估与调研“对试点城市调研评估是否值得推行”（2）
7. 责任划分与纠纷处理依现行法规处理“按《医疗事故处理条例》划分责任”（2）；“同临床纠纷处理方式”（2）
卫健机构主导划分“责任由卫健机构医政科划分”（1）
), ArticleFig(id=1324077980615574014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077975259447748, language=CN, label=表2, caption=

公共卫生医师处方权管理机制定性访谈结果

, figureFileSmall=null, figureFileBig=null, tableContent=
主类目子类目/关键观点代表性观点（频数）
1. 处方权赋予和管理机构行政部门主导“卫健委和疾控局共同赋予”（1）、“各级卫生行政部门”（3）
沿用临床医师管理机构“现行中临床医师由哪个机构管理，公卫医师就由哪个机构管理”（2）
2. 处方权赋予流程关键环节申请-培训-考核“提出申请、临床培训、考核合格”（2）、“注册备案+定期培训考核”（2）
反对赋予处方权“基层公卫医师缺员，增加工作量且无实际利好”（2）、“处方权意义有限，是否值得推广需评估”（2）
3. 政策与机制障碍法律法规限制“《执业医师法》限制公卫医师执业范围”（2）
职责定位冲突“公卫医师职责是疾病预防，非个体治疗”（4）
绩效考核矛盾“处方工作量考核削弱指令性任务完成”（2）
4. 日常监管与审查机制技术化监管工具“建立处方审核系统、患者反馈机制、定期抽查”（2）
行政部门定期审查“本级行政部门定期审查”（2）、“卫健委、疾控局”或“各级卫生行政部门”（4）
机构内部监管“机构出台制度+专家组审核”（3）
5. 培训与考核内容临床与法律知识“医学基础理论、公共卫生法律法规、临床知识、药物使用方法”（3）
技能更新与继续教育“定期开展新技能培训、案例分享与警示教育”（4）
6. 政策效果评估与优化体系化评估框架“构建评估指标、选择方法、建立优化机制”（2）
试点评估与调研“对试点城市调研评估是否值得推行”（2）
7. 责任划分与纠纷处理依现行法规处理“按《医疗事故处理条例》划分责任”（2）；“同临床纠纷处理方式”（2）
卫健机构主导划分“责任由卫健机构医政科划分”（1）
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多群体视角下公共卫生医师处方权管理机制构建——基于四川省的实证调查
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宋虹漪 , 熊柯尧 , 王滢 , 吴沁 , 田添 , 刘玲玲
现代预防医学 | 卫生政策与管理 2026,53(4): 688-693
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现代预防医学 |卫生政策与管理 2026 , 53 (4) : 688 -693
多群体视角下公共卫生医师处方权管理机制构建——基于四川省的实证调查
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宋虹漪（1995—），女，硕士，医师，研究方向：流行病与卫生统计学

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宋虹漪, 熊柯尧, 王滢, 吴沁, 田添, 刘玲玲
作者信息
  • 四川省疾病预防控制中心，四川 成都 610041
通讯作者:
刘玲玲，E-mail:
作者简介:

宋虹漪（1995—），女，硕士，医师，研究方向：流行病与卫生统计学

The construction of prescription management mechanism for public health physicians from a multi-group perspective: An empirical survey based on Sichuan Province
Hong-yi SONG, Ke-yao XIONG, Ying WANG, Qin WU, Tian TIAN, Ling-ling LIU
Affiliations
  • Sichuan Province Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
出版时间: 2026-02-25 doi: 10.20043/j.cnki.MPM.202509265
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摘要
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目的

了解四川省不同社会群体对公共卫生医师处方权管理机制构建的态度，为政府制定实施公共卫生医师处方权相关政策提供决策建议。

方法

采用问卷调查法结合专家深入访谈法，调查四川省各级疾控机构、综合医院、卫生行政部门、基层医疗机构及科研院校不同层级和不同职能的关键人员对公共卫生医师处方权赋予流程和管理机制构建的态度。

结果

调查对象支持公共卫生医师到三级医院进修合格（94.43%）或取得医师资格证（93.73%）后直接授予处方权。不同群体对处方权审批部门的认知差异显著，公共卫生医师（33.93%）和医学院校教师（42.47%）倾向省级卫生行政部门审批赋权，临床医师（33.74%）、卫生行政人员（31.25%）及患者（35.08%）更支持医师执业机构审批赋权。运行机制方面，调查对象支持由县（区）卫生行政部门（39.16%）对公共卫生医师处方权监督管理，开展两年一次（60.14%）的定期考核。

结论

公共卫生医师处方权的赋予应分层级、分机构、分科室稳步推进。建议构建分层培训路径与差异化考核标准以及“省级统筹-机构执行”双轨制监管体系，同时推动法律确权和闭环管理机制，确保公共卫生医师处方权的合法合规使用。

公共卫生医师  /  处方权  /  疾控体系改革  /  管理机制  /  运行机制
Objective

To investigate the attitudes of different groups towards the construction of a mechanism for managing the prescription rights of public health physicians in Sichuan Province, with the goal of offering references for policy-making.

Methods

Through questionnaires combined with in-depth expert interviews, relevant staff from CDCs, general hospitals, health administrative departments, primary healthcare institutions at various levels in Sichuan Province, and scientific research institutions were surveyed towards the process and management mechanism of granting prescription rights to public health physicians.

Results

The respondents supported granting prescription rights directly to public health physicians who passed the third level hospital training (94.43%) or obtained a physician qualification certificate (93.73%). There were significant differences in the perception of prescription approval departments among different groups. Public health physicians (33.93%) and medical school teachers (42.47%) tended to favor provincial health administrative department approval and empowerment, while clinical physicians (33.74%), health administrative personnel (31.25%), and patients (35.08%) were more supportive of physician practice institution approval and empowerment. In terms of operational mechanism, the survey respondents supported the supervision and management of public health physicians’ prescription rights by county (district) health administrative departments (39.16%), and conduct regular assessments every two years (60.14%).

Conclusion

The granting of prescription rights to public health physicians should be steadily promoted at different levels, institutions, and departments. It is suggested to establish a hierarchical training path and differentiated assessment standards, as well as a dual-track regulatory system of "provincial coordination institutional execution". At the same time, promote legal rights confirmation and closed-loop management mechanisms to ensure the legal and compliant use of prescription rights by public health physicians.

Public health practitioners  /  Prescription rights  /  Reform of the disease control system  /  Management mechanism  /  Operating mechanism
宋虹漪, 熊柯尧, 王滢, 吴沁, 田添, 刘玲玲. 多群体视角下公共卫生医师处方权管理机制构建——基于四川省的实证调查. 现代预防医学, 2026 , 53 (4) : 688 -693 . DOI: 10.20043/j.cnki.MPM.202509265
Hong-yi SONG, Ke-yao XIONG, Ying WANG, Qin WU, Tian TIAN, Ling-ling LIU. The construction of prescription management mechanism for public health physicians from a multi-group perspective: An empirical survey based on Sichuan Province[J]. Modern Preventive Medicine, 2026 , 53 (4) : 688 -693 . DOI: 10.20043/j.cnki.MPM.202509265
正文
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基本公共卫生服务是国家卫生健康的工作重点，也是实现“健康中国2030”既定目标的重要保障[1]。而在开展基本公共卫生服务时，却依然存在着“重医轻防”的现象[2]。随着“健康中国”战略的实施，不断扩大的基层医疗卫生服务项目、疫情防控常态化管理、慢性病医防融合服务模式等对公共卫生医师的能力提出了更高的要求和挑战[3]。为创新医防融合机制，提升公共卫生医师队伍的专业能力，2022年国家层面提出健全公共卫生医师制度，探索赋予公共卫生医师处方权。公共卫生医师处方权，是指依法获得相应资格的公共卫生医师，在规定的执业范围内，根据患者病情开具药物处方、检查检验申请单等医疗文书，实施疾病预防、控制、干预以及处置特定健康问题等医疗行为的权限[4]。
2023年以来，国家疾控局会同国家卫健委、医保局联合印发了试点工作方案，并率先在黑龙江、广东、海南、重庆等地启动了公共卫生医师处方权的试点工作，但整体仍处于探索阶段，尚未形成全国统一的实施方案，公共卫生医师处方权政策存在一定的模糊性和笼统性。现有公共卫生医师处方权研究大多集中在认知态度、发展困境等方面的分析[5-8]，对如何健全公共卫生医师处方权制度缺乏明确的政策指引，对公共卫生医师处方权准入条件和管理机制等方面未作详细说明。为弥补此方面研究空缺，本研究在四川省不同群体（卫生行政人员、临床医师、公共卫生医师、院校教师、社会受众）中开展了一轮针对处方权赋予流程和管理机制的横断面调查，同时对相关人员进行深入访谈，调查对公共卫生医师处方权赋予流程和管理机制的态度，为四川省进一步探索优化专项政策实施方案提供支持和参考。
1　对象与方法
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1.1　对象
本研究采用分层随机抽样结合关键人物法选取调查对象，包括四川省各级疾病预防控制中心（19个）、综合医院（18家）、基层医疗机构（社区卫生服务中心或乡镇卫生院）（24个）的公共卫生医师和临床医师，各级卫生行政部门（18个）的工作人员，医学科研院校（5所）的教师以及12个区（县）基层就医的患者或群众。
1.2　方法
1.2.1　调查内容
通过文献检索、专家头脑风暴、预调查等方法设计制作四川省探索赋予公共卫生医师处方权的调查问卷和公共卫生医师处方权研究专家深入访谈问卷。调查问卷包含3个部分19个问题，主要调查不同群体对处方权审批和运行机制的态度，具体为个人基本情况（8个）、处方权获取方式（5个）以及处方权赋予流程和管理（6个）等；专家深入访谈问卷包含4个部分，主要了解对公共卫生医师处方权管理机制的建议。
1.2.2　调查方法
按照四川省GDP高低，分三层随机抽取6个市（州）、12个区（县）作为调查地区，每个调查地区选取不同职能的关键人员作为调查对象，采用关键人物法和滚雪球法通过问卷星开展在线横断面研究，共调查1 710人。专家深入访谈法通过选取医疗卫生领域相关专家进行专题访谈，根据结构化访谈提纲，在线发送开放性问题清单，专家书面作答。
1.2.3　质量控制
调查前对调查人员进行统一培训，由专人负责质控工作。数据收集过程中，如发现不合逻辑异常值等作修正或剔除处理。本问卷整体的一致性信度Cronbach α系数为0.719 3，平均项目间协方差为0.037，提示问卷信度和效度较好。
1.3　统计分析
通过Excel 2013软件录入问卷信息，使用SPSS 25.0软件进行统计学检验，定量资料使用率、占比、均数等进行统计学描述，组间差异比较采用χ2检验，检验水准α=0.05。定性资料（专家深入访谈结果）采用主题分析法和内容编码法归纳整理。
2　结果
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2.1　调查对象基本情况
发放调查问卷1 710份，回收有效问卷1 706份，有效率99.77%。调查对象包括临床医师492人（28.84%）、公共卫生医师448人（26.26%）、卫生行政人员368人（21.57%）、社会受众或患者325人（19.05%）和医学院校教师73人（4.28%）。其中男女占比分别为41.15%和58.85%，年龄30~39岁、大学本科、初级及以下人员占比最高，分别为36.81%、53.11%和52.87%。专业以临床医学为主（29.25%），其次为预防医学（24.79%）。
2.2　对公共卫生医师处方权审批机制的态度调查
2.2.1　获取方式
不同群体对处方权获取方式的认知差异均有统计学意义（P<0.001）。调查对象支持多种公共卫生医师处方权获取方式，包括三级医院进修结合考试（94.43%）、通过医师资格证考试（93.73%）、一年期全科医学培训（92.61%）以及两年期规范化培训（91.68%）后直接授予处方权。在各类处方权获取方式的均值支持率中社会受众（患者）最高，为97.39%，公共卫生医师最低，为88.06%；不同群体对各类处方权获取方式的支持率不同，其中医学院校教师对全科培训和综合医院进修支持率均最低（83.56%和90.41%）。见表1。
2.2.2　审批部门
不同群体对公共卫生医师处方权审批部门的认知差异均有统计学意义（P<0.001）。调查对象支持由医师执业机构审批赋予公共卫生医师处方权（31.01%），其次是省级卫生行政部门（28.14%）和县（区）卫生行政部门（26.44%）。公共卫生医师（33.93%）和医学院校教师（42.47%）更倾向省级卫生行政部门，临床医师（33.74%）和卫生行政人员（31.25%）偏向医师执业机构，患者（社会受众）更信任医师执业机构（35.08%）和县（区）卫生行政部门（34.46%）。见图1。
2.3　对公共卫生医师处方权运行机制的态度调查
2.3.1　行使地点
调查对象支持公共卫生医师行使处方权的地点有多种，社区卫生服务中心或卫生院占比最高，为87.81%；其次是疾控中心门诊部或对外服务部门，占比79.95%；其余依次为综合性医院（54.81%）、传染病医院（51.88%）、妇幼保健院（44.02%）和其他（1.52%）。
2.3.2　监管主体
不同群体对处方权监督管理部门的态度差异均有统计学意义（P<0.001）。调查对象支持公共卫生医师取得处方权后由县（区）卫生行政部门进行监督管理（39.16%），其次是医师执业机构（27.26%）、省级卫生行政部门（18.29%）和市（州）卫生行政部门（15.3%）。卫生行政人员、临床医师、公共卫生医师、社会受众（患者）倾向由县（区）卫生行政部门监督管理，而医学院校教师更倾向由省级卫生行政部门监督管理，县（区）卫生行政部门的支持率最低。见图2。
2.3.3　监管方式
95.13%的调查对象认为公共卫生医师取得处方权后需要定期考核，包括两年一次（60.14%）、三年一次（22.98%）或五年一次（15.65%），4.87%的调查对象认为不需要对取得处方权的公共卫生医师开展定期考核。
2.4　公共卫生医师处方权管理机制定性访谈
定性访谈6名来自市州疾控中心疾控科、附属医院综合管理科、慢性病防控科和健康教育科的专家。访谈对象学历均为大学本科，副高级职称占比50%，中级职称占比33.33%，职业包括公共卫生医师（66.67%）和临床医师（33.33%）。通过主题分析法和内容编码法对访谈结果归纳整理。见表2。
2.4.1　政策与机制障碍
6名专家均认为公共卫生医师处方权赋予和管理的政策合法性欠缺。其中33.33%的访谈对象认为公共卫生医师执业范围定义不明确，公共卫生医师作为法定执业医师，其处方权虽然在《处方管理办法》和《中华人民共和国医师法》中有明确说明，但目前无专门的政策法规出台，明确执业范围是公共卫生医师处方权的核心问题之一。66.67%的访谈对象认为公共卫生医师的主要职责是预防和控制疾病，服务对象是人群，而非直接治疗个体患者。国家层面可推动修订《执业医师法》，明确公共卫生医师处方权法律边界，制定分级授权标准，同时将公共卫生医师纳入医疗机构的常态化培训体系，确保知识技能持续更新。
2.4.2　实施效果评估与优化
33.33%的访谈对象认为应该建立实施效果的持续评估体制，不断优化公共卫生医师处方权赋予的相关政策。处方权管理部门可建立电子处方审核系统，设立监管专员抽查处方质量，并通过患者反馈机制监测处方合理性。通过构建体系化评估框架和学习试点城市先进经验，形成“赋权—监管—评估—迭代”的闭环管理。
2.4.3　责任划分与纠纷处理
访谈对象均认同公共卫生医师处方权赋予后的责任纠纷处理是涉及法律、医疗、公共卫生等多领域的复杂问题。目前国家正处于处方权试点探索阶段，相关责任划分尚未形成统一的法律框架，但可基于现有医疗责任体系和试点城市经验进行原则性分析。66.67%的访谈对象认为公共卫生医师在诊疗过程中出现医患纠纷或医疗事故时应按照《医疗事故处理条例》等现行法律法规处理，16.67%的访谈对象认为应由卫健机构主导划分责任。
3　讨论
收起
3.1　分层级、分机构、分科室稳步有序赋予处方权
本研究展示了社会受众（患者）群体对处方权有强烈的需求，不同群体支持公共卫生医师通过多种方式获得处方权。公共卫生医师是基层公共卫生服务的主要提供者，其处方权缺失已造成基层医防分离，影响了基本公共卫生服务工作成效，公共卫生医师本身亦产生职业价值危机[5]。公共卫生医师处方权主要应用于居民健康管理，能提升基层服务效率，满足对便捷医疗服务的需求。同时本研究展示了参与调查的公共卫生医师对各类处方权获取方式支持率相对保守，原因可能在于对自身专业能力要求更严格，担心培训不足导致处方权滥用风险，或是长期边缘化导致对政策落地缺乏信心。公共卫生医师的核心职责是群体疾病预防，与临床个体化诊疗存在目标冲突，直接赋予处方权可能导致职责越位。针对各地区经济发展水平、公共卫生资源配置情况等因素，通过分级分类的方式有序赋予处方权。试点工作可以首先在基层医疗卫生机构开展，再逐步向疾控机构门诊部或对外服务部门开放。本研究调查结果与相关省份试点方案相互印证[9-12]，具有科学性和可持续性。
3.2　建立分层设计培训路径与差异化考核标准
公共卫生医师可通过规范化培训、全科医师培训、综合医院进修等方式，考核合格后获得处方权。培训内容包括临床与法律知识、技能培训、处方权范围和处方开具等，满足不同群体需求，提升临床专业知识和技能[5,13]。持有资格证书和执业证书的公共卫生医师可通过“按需申请-临床培训-考核合格-授予处方权”的流程获得一定范围的处方权，这与目前在岗公共卫生医师的实际情况相一致。处方权审批赋予部门可由医师执业机构或各级卫生行政部门主导，统一制定差异化定期考核标准，对培训成果进行评估和反馈，确保申请赋权的公共卫生医师具备提供相应医疗卫生服务的能力。
3.3　构建“省级统筹-机构执行”双轨制监督管理体系
本研究发现不同群体对公共卫生医师处方权监督管理部门的态度存在显著差异。公共卫生医师主张权责赋予主体应上移至省级卫生行政部门以强化权威性，而监督管理则下沉至县（区）级卫生行政部门以体现权责分离需求；患者与临床医师更信任“就近管理”模式，支持由县（区）级行政部门或执业机构直接赋权并监管。卫生行政人员与医学院校教师倾向由省级统筹管理以提升政策执行效率，而患者与公共卫生医师偏好地方化监管以保留灵活性。基于研究结果，可构建“省级统筹-机构执行”双轨制监督管理体系，省级层面设立处方权准入标准与跨区域协调机制，县（区）级层面则通过前置审批、临床质量联控及电子处方追溯平台落实属地管理。
3.4　推动法律确权与闭环管理机制
基于专家深度访谈结果，公共卫生医师处方权的管理机制面临着政策合法性缺失与职责冲突、监管体系薄弱以及责任界定与纠纷处理机制模糊等核心挑战，需要通过制度创新实现管理机制的完善。现行《医疗事故处理条例》中未明确区分公共卫生医师与临床医师责任，为避免权责不对等风险，需补充权责清单，明确公共卫生医师执业范围。访谈专家呼吁建立电子处方审核系统与患者反馈机制，通过AI实时监测处方合理性，建立疾控监督员日常巡查与上级/第三方定期审查的双重监管体系，将处方行为纳入临床质量管理。同时构建“试点城市经验共享平台”，推动跨区域政策优化，形成“赋权—监管—评估—迭代”的闭环管理机制。

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2026年第53卷第4期
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doi: 10.20043/j.cnki.MPM.202509265
  • 接收时间：2025-09-16
  • 首发时间：2026-11-02
  • 出版时间：2026-02-25
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  • 收稿日期：2025-09-16
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    四川省疾病预防控制中心，四川 成都 610041

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