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Article(id=1241319158273594239, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409151, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725811200000, receivedDateStr=2024-09-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883149927, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883149927, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883149927, creator=13701087609, updateTime=1773883149927, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2230, endPage=2235, ext={EN=ArticleExt(id=1241319159070512068, articleId=1241319158273594239, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Discussion and analysis on the scope of practice of public health doctors’ rights to prescribe, Sichuan province, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the public’s intention on the scope of granting prescribing rights to public health physicians, to provide reference opinions on the pilot work in progress in China, and to provide scientific basis and support for further exploring the policy formulation and promotion of granting prescribing rights to public health physicians in the province.

Methods

Using snowball method to conduct this survey, combined with personal interview method to collect the suggestions of different occupational groups in Sichuan province on the different scope of practice of public health doctors.

Results

A total of 1 706 valid questionnaires were collected in this study. The results showed that 89.45% of the respondents supported giving public health doctors the right to prescribe, 76.85%-83.06% of the respondents suggested that public health doctors’ right to prescribe diseases such as infectious diseases, chronic diseases, occupational diseases, parasites and endemic diseases be completely lifted. 90.97% of the respondents believed that public health doctors should be allowed to prescribe non-drug interventions to patients with chronic diseases and people at risk of chronic diseases.

Conclusion

Based on the existing pilot programme, the subsequent scope of practice of public health physicians’ prescriptive authority should be further improved, and consideration should be given to the gradual trial implementation of prescriptive authority for non-pharmacological interventions, so as to give full play to the functional advantages of public health physicians as prevention-oriented physicians, and at the same time the mechanism for the training, development and assessment of public health physicians should be strengthened, in order to provide the grass-roots level with a high-quality team of public health physicians.

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目的

了解公众对赋予公卫医师处方权范围的意向，对我国开展中的试点工作提供参考意见，为进一步探索我省赋予公卫医师处方权的政策制定和推动提供科学依据和支撑。

方法

采用滚雪球法开展电子问卷，结合个人访谈法调查四川省不同社会群体对公卫医师处方权执业范围的建议开放情况。

结果

本研究共回收1 706份有效问卷，结果表明：89.45%的调查对象支持赋予公卫医师处方权，76.85%~83.06%的调查对象建议完全放开公卫医师针对传染病、慢性病、职业病、寄生虫及地方病等疾病范围的诊疗处方权，90.97%的调查对象认为应该允许公卫医师对慢性病患者和慢性病风险人群开具非药物干预的健康处方。

结论

基于现有的试点方案，后续公卫医师处方权执业范围应进一步完善，考虑逐步试行非药物干预处方权，充分发挥公卫医师预防为主的职能优势，同时应强化公卫医师培养、培训以及考核机制，为基层提供优质的公卫医师队伍。

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刘玲玲，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=yxz9jHrbW63efKXhpboP4A==, magXml=KTX5BE1z0eyBZjRs7266/A==, pdfUrl=null, pdf=SWAwF29GbRd/fHYVKh80fw==, pdfFileSize=1158166, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=z37SQoJYz9ys0TziD+54qg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=MXEwVaedHj4zZHR9Jd3dRw==, mapNumber=null, authorCompany=null, fund=null, authors=

吴沁（1995—），女，硕士，医师，研究方向：流行病学

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吴沁（1995—），女，硕士，医师，研究方向：流行病学

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吴沁（1995—），女，硕士，医师，研究方向：流行病学

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(In Chinese), articleTitle=Implications of Dr C.C.Chen’s public health practice for improving medical practicing system of public health physicians, refAbstract=null), Reference(id=1241319176904692294, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=12, pageStart=1610, pageEnd=1616, url=null, language=null, rfNumber=[28], rfOrder=54, authorNames=王黎黎, 刘学成, 孙莉, journalName=预防医学情报杂志, refType=null, unstructuredReference=王黎黎，刘学成，孙莉，等．2021年四川省疾病预防控制机构人员能力现状分析[J].预防医学情报杂志，2022,38(12):1610-1616．, articleTitle=2021年四川省疾病预防控制机构人员能力现状分析, refAbstract=null), Reference(id=1241319176992772679, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=12, pageStart=1610, pageEnd=1616, url=null, language=null, rfNumber=[28], rfOrder=55, authorNames=Wang LL, Liu XC, Sun L, journalName=Journal of Preventive Medicine Information, refType=null, unstructuredReference=Wang LL, Liu XC, Sun L, et al. Status analysis of personnel capacity of centers for disease control and prevention in Sichuan Province in 2021[J]. Journal of Preventive Medicine Information, 2022, 38(12): 1610-1616. (In Chinese), articleTitle=Status analysis of personnel capacity of centers for disease control and prevention in Sichuan Province in 2021, refAbstract=null), Reference(id=1241319177068270152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, doi=null, pmid=null, pmcid=null, year=2018, volume=34, issue=5, pageStart=707, pageEnd=710, url=null, language=null, rfNumber=[29], rfOrder=56, authorNames=杜莹, 陈若男, 刘威, journalName=职业与健康, refType=null, unstructuredReference=杜莹，陈若男，刘威，等．我国公共卫生医师规范化培训的现状[J].职业与健康，2018,34(5):707-710．, articleTitle=我国公共卫生医师规范化培训的现状, refAbstract=null), Reference(id=1241319177168933449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, doi=null, pmid=null, pmcid=null, year=2018, volume=34, issue=5, pageStart=707, pageEnd=710, url=null, language=null, rfNumber=[29], rfOrder=57, authorNames=Du Y, Chen RN, Liu W, journalName=Occupation and Health, refType=null, unstructuredReference=Du Y, Chen RN, Liu W, et al. Current situation of standardized training for public health physicians in China[J]. Occupation and Health, 2018, 34(5): 707-710. (In Chinese), articleTitle=Current situation of standardized training for public health physicians in China, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241319160265887780, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, xref=null, ext=[AuthorCompanyExt(id=1241319160274276390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, companyId=1241319160265887780, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610000, China), AuthorCompanyExt(id=1241319160286859307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, companyId=1241319160265887780, 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=1241319167706583385, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=EN, label=Fig.1, caption=Proposed liberalisation of the scope of prescribing authority for public health physicians by the public health physician community, figureFileSmall=bXz6Mcr8HZvQaleENIWnZg==, figureFileBig=z37SQoJYz9ys0TziD+54qg==, tableContent=null), ArticleFig(id=1241319167807246687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=CN, label=图1, caption=公卫医师群体对公卫医师处方权范围建议放开情况, figureFileSmall=bXz6Mcr8HZvQaleENIWnZg==, figureFileBig=z37SQoJYz9ys0TziD+54qg==, tableContent=null), ArticleFig(id=1241319168016961897, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=EN, label=Fig.2, caption=Health administrators’ openness to scope of practice proposals for public health physicians’ prescriptive authority, figureFileSmall=sf2cnEqR33w9XXNwG29pQg==, figureFileBig=rWuiRFzbyb32sDVQxaVkYg==, tableContent=null), ArticleFig(id=1241319168130208110, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=CN, label=图2, caption=卫生行政人员对公卫医师处方权执业范围建议开放情况

注：A:本研究调查的卫生行政人员组成情况；B:不同层级和机构来源的卫生行政人员对四类疾病处方权的建议开放比例。

, figureFileSmall=sf2cnEqR33w9XXNwG29pQg==, figureFileBig=rWuiRFzbyb32sDVQxaVkYg==, tableContent=null), ArticleFig(id=1241319168247648627, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=EN, label=Table 1, caption=

Basic Characteristics of Survey Respondents on Prescribing Rights of Public Health Physicians in Sichuan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
样本特征人数构成比（%）
性别
男70241.15
女1 00458.85
年龄(岁)
<3035520.80
30~3962836.81
40~4943125.26
≥5029217.12
学历
硕士研究生及以上26615.59
大学本科90653.11
大专35220.63
中专及以下18210.67
专业
预防医学42324.79
临床医学49929.25
护理学20011.72
中医学1418.26
其他医学672.93
其他专业37622.04
职称
高级31118.23
中级49328.90
初级51430.13
无38822.74
职业
公共卫生医师44826.26
临床医师49228.84
卫生行政人员36821.57
医学院校教师734.28
社会受众（患者）32519.05
合计1 706100.00
), ArticleFig(id=1241319168356700537, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=CN, label=表1, caption=

四川省公共卫生医师处方权调查对象基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
样本特征人数构成比（%）
性别
男70241.15
女1 00458.85
年龄(岁)
<3035520.80
30~3962836.81
40~4943125.26
≥5029217.12
学历
硕士研究生及以上26615.59
大学本科90653.11
大专35220.63
中专及以下18210.67
专业
预防医学42324.79
临床医学49929.25
护理学20011.72
中医学1418.26
其他医学672.93
其他专业37622.04
职称
高级31118.23
中级49328.90
初级51430.13
无38822.74
职业
公共卫生医师44826.26
临床医师49228.84
卫生行政人员36821.57
医学院校教师734.28
社会受众（患者）32519.05
合计1 706100.00
), ArticleFig(id=1241319168469946754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=EN, label=Table 2, caption=

Proposed opening of the scope of practice for the prescriptive authority of public health physicians

, figureFileSmall=null, figureFileBig=null, tableContent=
执业范围完全放开部分放开不放开
人数构成比（%）人数构成比（%）人数构成比（%）
传染病诊疗与暴露后预防用药1 31176.851166.8027916.35
慢性病（高血压、糖尿病等）诊疗1 41783.06844.9220512.02
职业病诊疗1 37180.36523.0528316.59
寄生虫病、地方病诊疗1 41683.00392.2925114.71
), ArticleFig(id=1241319168566415750, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=CN, label=表2, caption=

公卫医师处方权执业范围建议开放情况

, figureFileSmall=null, figureFileBig=null, tableContent=
执业范围完全放开部分放开不放开
人数构成比（%）人数构成比（%）人数构成比（%）
传染病诊疗与暴露后预防用药1 31176.851166.8027916.35
慢性病（高血压、糖尿病等）诊疗1 41783.06844.9220512.02
职业病诊疗1 37180.36523.0528316.59
寄生虫病、地方病诊疗1 41683.00392.2925114.71
), ArticleFig(id=1241319168675467660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=EN, label=Table 3, caption=

Presentation of results of in-depth expert interviews

, figureFileSmall=null, figureFileBig=null, tableContent=
主范畴范畴（频数）初始概念（频数）
B01利弊A01好处（20）提高医疗服务水平（5）、减轻基层负担（4）、提高疾病管理效率（4）、促进传染病防治（3）、规范慢病随访（2）、促进医防融合（2）
A02弊端（8）监管难度增加（4）、潜在安全风险（2）、职责不清（2）、增加工作量（1）
B02赋予机制障碍A03法律法规限制（6）法律和法规的限制（5）、法律未能保障（1）
A04专业定位和职责（6）实际工作限制（3）、专业定位和职责不同（2）、完成指令性任务（1）
A05社会认同感低（2）患者信任担忧（2）
B03政策的落实A06明确执业范围（6）明确执业范围（2）、应用规范（2）、处方内容和范围（1）
A07培训和考核（5）严格培训和考核（4）、具备执业条件（1）
A08监督和管理（4）监督和管理（2）、监管机制（2）
B04执业范围限定依据A09法律与政策框架（6）法律法规限制（4）、法律和政策允许（1）、法律框架（1）
A10专业背景（4）专业背景限制（3）、专业条件（1）
B05具体疾病或健康问题权限A11慢性病（5）慢性病（3）、慢病管理（2）、
A12传染病（7）传染病（3）、传染病防控（2）、预防接种（2）
A13职业病（5）职业病（3）、职业病康复治疗（2）
A14地方病（4）地方病（2）、地方病防治（2）
A15其他公共卫生问题（5）妇女和儿童保健（2）、心理疾病咨询（2）、公共卫生或群体健康问题（1）
B06预防性用药权限A16慢病和传染病（2）慢性病和传染病管理（2）
A17妇女围孕期和儿童保健（4）妇女围孕期保健（2）、儿童保健（2）
A18其他公共卫生需求（3）公共卫生需求（2）、其他特定疾病（1）
A19国家目录（1）国家制定目录（1）
B07非药物干预处方A20必要（21）提升公卫服务质量（2）、利于综合健康管理（2）、利于疾病预防和控制（5）、优化医疗资源（2）、提高生活质量（2）、提升大众健康（3）、辅助治疗（3）、减轻医疗负担（2）
A21不必要（1）以健康教育形式呈现（1）
B08非药物干预处方实施难点A22专业能力（6）专业资质要求（2）、从业人员水平层次不齐（2）、缺乏相关知识（2）
A23医患关系（6）信任建立（2）、患者参与度（2）、依从性差（2）
A24自身价值（4）科学依据不足（2）、疗效评估（2）
B09处方权的管理A25培训和考核（6）资格认证（2）、规范化培训（2）、培训和考核机制（2）
A26法律法规（8）授予和考核机制（2）、完善相关法律法规（4）、医学伦理规范（2）
), ArticleFig(id=1241319168805491090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319158273594239, language=CN, label=表3, caption=

专家深入访谈结果展示

, figureFileSmall=null, figureFileBig=null, tableContent=
主范畴范畴（频数）初始概念（频数）
B01利弊A01好处（20）提高医疗服务水平（5）、减轻基层负担（4）、提高疾病管理效率（4）、促进传染病防治（3）、规范慢病随访（2）、促进医防融合（2）
A02弊端（8）监管难度增加（4）、潜在安全风险（2）、职责不清（2）、增加工作量（1）
B02赋予机制障碍A03法律法规限制（6）法律和法规的限制（5）、法律未能保障（1）
A04专业定位和职责（6）实际工作限制（3）、专业定位和职责不同（2）、完成指令性任务（1）
A05社会认同感低（2）患者信任担忧（2）
B03政策的落实A06明确执业范围（6）明确执业范围（2）、应用规范（2）、处方内容和范围（1）
A07培训和考核（5）严格培训和考核（4）、具备执业条件（1）
A08监督和管理（4）监督和管理（2）、监管机制（2）
B04执业范围限定依据A09法律与政策框架（6）法律法规限制（4）、法律和政策允许（1）、法律框架（1）
A10专业背景（4）专业背景限制（3）、专业条件（1）
B05具体疾病或健康问题权限A11慢性病（5）慢性病（3）、慢病管理（2）、
A12传染病（7）传染病（3）、传染病防控（2）、预防接种（2）
A13职业病（5）职业病（3）、职业病康复治疗（2）
A14地方病（4）地方病（2）、地方病防治（2）
A15其他公共卫生问题（5）妇女和儿童保健（2）、心理疾病咨询（2）、公共卫生或群体健康问题（1）
B06预防性用药权限A16慢病和传染病（2）慢性病和传染病管理（2）
A17妇女围孕期和儿童保健（4）妇女围孕期保健（2）、儿童保健（2）
A18其他公共卫生需求（3）公共卫生需求（2）、其他特定疾病（1）
A19国家目录（1）国家制定目录（1）
B07非药物干预处方A20必要（21）提升公卫服务质量（2）、利于综合健康管理（2）、利于疾病预防和控制（5）、优化医疗资源（2）、提高生活质量（2）、提升大众健康（3）、辅助治疗（3）、减轻医疗负担（2）
A21不必要（1）以健康教育形式呈现（1）
B08非药物干预处方实施难点A22专业能力（6）专业资质要求（2）、从业人员水平层次不齐（2）、缺乏相关知识（2）
A23医患关系（6）信任建立（2）、患者参与度（2）、依从性差（2）
A24自身价值（4）科学依据不足（2）、疗效评估（2）
B09处方权的管理A25培训和考核（6）资格认证（2）、规范化培训（2）、培训和考核机制（2）
A26法律法规（8）授予和考核机制（2）、完善相关法律法规（4）、医学伦理规范（2）
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四川省公共卫生医师处方权执业范围探讨分析
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吴沁 , 罗中根 , 宋虹漪 , 王滢 , 田添 , 熊柯尧 , 吴镝 , 张桦林 , 刘玲玲
现代预防医学 | 卫生政策与管理 2025,52(12): 2230-2235
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现代预防医学 | 卫生政策与管理 2025, 52(12): 2230-2235
四川省公共卫生医师处方权执业范围探讨分析
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吴沁, 罗中根, 宋虹漪, 王滢, 田添, 熊柯尧, 吴镝, 张桦林, 刘玲玲
作者信息
  • 四川省疾病预防控制中心，四川 成都 610041

    • 吴沁（1995—），女，硕士，医师，研究方向：流行病学

通讯作者:

刘玲玲，E-mail：
Discussion and analysis on the scope of practice of public health doctors’ rights to prescribe, Sichuan province
Qin WU, Zhong-gen LUO, Hong-yi SONG, Ying WANG, Tian TIAN, Ke-yao XIONG, Di WU, Hua-lin ZHANG, Ling-ling LIU
Affiliations
  • Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610000, China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202409151
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摘要
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目的

了解公众对赋予公卫医师处方权范围的意向，对我国开展中的试点工作提供参考意见，为进一步探索我省赋予公卫医师处方权的政策制定和推动提供科学依据和支撑。

方法

采用滚雪球法开展电子问卷，结合个人访谈法调查四川省不同社会群体对公卫医师处方权执业范围的建议开放情况。

结果

本研究共回收1 706份有效问卷，结果表明：89.45%的调查对象支持赋予公卫医师处方权，76.85%~83.06%的调查对象建议完全放开公卫医师针对传染病、慢性病、职业病、寄生虫及地方病等疾病范围的诊疗处方权，90.97%的调查对象认为应该允许公卫医师对慢性病患者和慢性病风险人群开具非药物干预的健康处方。

结论

基于现有的试点方案，后续公卫医师处方权执业范围应进一步完善，考虑逐步试行非药物干预处方权，充分发挥公卫医师预防为主的职能优势，同时应强化公卫医师培养、培训以及考核机制，为基层提供优质的公卫医师队伍。

公卫医师  /  处方权  /  执业范围  /  非药物干预处方
Objective

To understand the public’s intention on the scope of granting prescribing rights to public health physicians, to provide reference opinions on the pilot work in progress in China, and to provide scientific basis and support for further exploring the policy formulation and promotion of granting prescribing rights to public health physicians in the province.

Methods

Using snowball method to conduct this survey, combined with personal interview method to collect the suggestions of different occupational groups in Sichuan province on the different scope of practice of public health doctors.

Results

A total of 1 706 valid questionnaires were collected in this study. The results showed that 89.45% of the respondents supported giving public health doctors the right to prescribe, 76.85%-83.06% of the respondents suggested that public health doctors’ right to prescribe diseases such as infectious diseases, chronic diseases, occupational diseases, parasites and endemic diseases be completely lifted. 90.97% of the respondents believed that public health doctors should be allowed to prescribe non-drug interventions to patients with chronic diseases and people at risk of chronic diseases.

Conclusion

Based on the existing pilot programme, the subsequent scope of practice of public health physicians’ prescriptive authority should be further improved, and consideration should be given to the gradual trial implementation of prescriptive authority for non-pharmacological interventions, so as to give full play to the functional advantages of public health physicians as prevention-oriented physicians, and at the same time the mechanism for the training, development and assessment of public health physicians should be strengthened, in order to provide the grass-roots level with a high-quality team of public health physicians.

Public health doctors  /  The right to prescribe  /  Scope of practice  /  Non-drug intervention prescription
吴沁, 罗中根, 宋虹漪, 王滢, 田添, 熊柯尧, 吴镝, 张桦林, 刘玲玲. 四川省公共卫生医师处方权执业范围探讨分析. 现代预防医学, 2025 , 52 (12) : 2230 -2235 . DOI: 10.20043/j.cnki.MPM.202409151
Qin WU, Zhong-gen LUO, Hong-yi SONG, Ying WANG, Tian TIAN, Ke-yao XIONG, Di WU, Hua-lin ZHANG, Ling-ling LIU. Discussion and analysis on the scope of practice of public health doctors’ rights to prescribe, Sichuan province[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2230 -2235 . DOI: 10.20043/j.cnki.MPM.202409151
正文
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公卫医师是我国公共卫生和疾病预防控制人才队伍的中坚力量[1]，但目前存在队伍不稳定、专业能力逐渐弱化、疾病防控能力不能充分发挥等问题，这与公卫医师处方权的缺失存在一定关系[2-3]。为促进“医防融合”，为群众提供全周期医疗保障，完善医疗服务体系，我国相继出台多个文件，明确指出“健全公卫医师制度，探索赋予公共卫生医师处方权”[4-5]。广东、海南、重庆、黑龙江等地率先启动公卫医师处方权试点工作，标志着我国公卫医师处方权赋权的探索进入了实践阶段[6]。
我国公卫医师的执业范围限定为公共卫生类别专业，包括疾病控制、公共卫生、健康教育等，同时医师法中规定：“医师不得出具与自己执业范围无关或者与职业类别不相符的医学证明文件，不得超范围执业”[7]。由此可见，探索赋予公卫医师处方权的核心问题之一应是厘清率先开放领域、有限开放领域，明确标准、分级分类。
目前，部分关于公卫医师处方权认知的调查群体局限，并且针对公卫医师处方权执业范围的研究也较为缺乏[8-10]。四川省作为我国西南地区的重要省份，强化公共卫生体系，促进医防融合一直是四川建设的重要抓手。2023年四川省成为首批医疗机构疾控监督员制度试行省份，随之而来的将会是公卫医师处方权试点工作[11]。鉴此，本研究旨在调查公众对赋予公卫医师处方权范围的意向，对我国开展中的试点工作提供参考意见，为进一步探索我省赋予公卫医师处方权的政策制定和推动提供科学依据和支撑。
1　对象与方法
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1.1　对象
四川省公共卫生系统中不同层级和职能的关键人员，包括省、市、县各级疾控中心、卫生行政部门、医疗机构、医学院校以及社区卫生服务中心或乡镇卫生院等单位的公卫医师、临床医师、行政人员、教师以及基层就医患者或群众。本研究已通过四川省疾控中心伦理委员会审核批准（审查批准号：SCCDCIRB第2025-013号），调查对象均知情同意。
1.2　方法
1.2.1　调查方法和内容
按照四川省GDP“好、中、差”分层随机抽取6个市（州）、12个区（县）作为调查地区，在每个调查地区进一步选取相关单位的关键人员作为调查对象，采用滚雪球法开展电子问卷调查，问卷包括3大部分15道题，包括调查对象基本情况、对公卫医师处方权的认知态度、公卫医师处方权的执业范围等内容。对医疗卫生体系的专家进行深入访谈，了解专家对赋予公卫医师处方权的看法、执业范围限定的依据、建议开放的范围以及实施的困难、建议及对策等内容，利用内容编码法整理访谈结果。
1.2.2　质量控制
利用Cronbach alpha系数评估问卷一致性，整体问卷α=0.719 3，平均项目间协方差0.037，内部一致性较好。所有异常值均经过核实后修正或剔除处理。
1.3　统计分析
采用Excel 2013软件对数据进行汇总统计，SPSS 25.0软件进行统计学检验，组间比较采用非参数检验，其中多组等级资料采用Kruskal-Wallis秩和检验，检验水准α=0.05。
2　结果
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2.1　基本情况
本次调查共回收1 710份问卷，数据质控后剩余1 706份有效问卷，有效率为99.77%。调查对象男女比例为1:1.4，30~50岁人群占比62.07%；大学本科及以上学历占比68.70%；中级及以上职称占比47.13%；公卫医师：临床医师：行政人员：医学院校教师：社会受众（患者）≈6.1:6.7:5:1:4.5，见表1。
2.2　公卫医师、处方权的认知态度调查
76.84%的调查对象了解公卫医师，76.91%的调查对象了解处方权。不同社会群体中，公卫医师了解公卫医师的比例最高（92.64%），了解处方权的比例仅高于社会受众（分别为72.54%和58.46%）；临床医师了解处方权的比例最高（90.45%），了解公卫医师的占比仅高于社会受众（分别为72.77%和59.39%），卫生行政人员和医学院校教师对公卫医师处方权的认知水平处于平均水平。89.45%的调查对象支持赋予公卫医师处方权，支持率由高到低分别为：医学院校教师（94.52%）、社会受众（92.31%）、卫生行政人员（90.76%）、公卫医师（87.28%）和临床医师（87.60%）。
2.3　公卫医师处方权执业范围建议开放情况
2.3.1　传染病、慢性病、寄生虫、地方病及职业病诊疗处方
调查结果显示，76.85%~83.06%的调查对象建议完全放开表中四种疾病类型的诊疗处方权，其中慢性病类别占比最高，其次是寄生虫及地方病类别；2.29%~6.80%的调查对象认为应该部分放开，其中针对传染病诊疗和暴露后预防用药的占比最高，寄生虫及地方病诊疗占比最低，见表2。
2.3.2　非药物干预处方
12.02%的调查对象建议对公卫医师放开其他非药物干预处方权，涉及运动、膳食、营养、心理、睡眠、中医（理疗）等方面。90.97%的调查对象认为应该允许公卫医师对慢性病患者和慢性病风险人群开具非药物干预的健康处方，其中排名前三的是饮食处方、营养处方及运动处方，依次占比为93.94%、93.04%和90.72%。
2.3.3　公卫医师群体对处方权范围建议开放情况
本次调查共包括448名公卫医师，其中基层医疗卫生机构108名，疾控中心287名，卫生行政管理机构10名，医院40名，医学院校3名。74.10%~80.80%的公卫医师建议完全放开四种疾病类型的诊疗处方权，其中慢性病比例最高，其次是寄生虫及地方病，此结果在不同机构中相同，见图1。基层和疾控中分别有93.3%和85.2%的公卫医师认为应该允许公卫医师对慢性病患者和慢性病风险人群开具非药物干预的健康处方。
2.3.4　卫生行政群体对处方权范围建议开放情况
本次调查共包含368名卫生行政人员，其中卫生行政管理机构165名，医疗卫生机构192名，其他单位11名。81.80%~86.10%的卫生行政人员建议完全放开公卫医师针对四类疾病类型的诊疗处方权，其中慢性病和寄生虫及地方病比例最高，且不同层级的医疗卫生机构比例普遍高于相应层级的卫生行政管理机构。不同层级卫生行政人员中，基层医疗卫生机构建议完全放开四类疾病类型诊疗处方权的比例最高，其次是区（县）级疾控中心，见图2。89.4%的卫生行政人员支持开放公卫医师对慢性病患者和慢性病风险人群的非药物干预的健康处方，区(县)级卫生行政管理机构和基层医疗卫生机构的支持率最高。
2.4　专家深入访谈
本次研究共访谈6名专家，经过访谈内容整理归纳、编码后，获得表3。据结果所示，专家认为赋予公卫医师处方权的利大于弊，但是需要加强监管，避免潜在的安全风险。目前公卫医师处方权的赋予和推广主要存在法律法规不完善、公卫医师临床专业能力不足以及职责定位等障碍。公卫医师处方权的实施需要先明确执业范围，同时强化标准化培训和考核，严格处方权资格认证以及加强监督和管理是推动公卫医师处方权落地的基础。执业范围的限定应以专业背景限制、法律与政策框架为前提，覆盖慢性病、传染病、职业病以及地方病、妇女儿童保健、公共健康干预等具体的群体性疾病或健康问题及其他法规明确的公共卫生需求。非药物干预处方以及预防性用药有助于综合健康管理的实施以及慢病和传染病的防治。
3　讨论
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3.1　公卫医师处方权试点工作具有可持续性
本研究对象涵盖了公共卫生体系中不同层级和职能的关键人员，结合定量问卷和定性专家访谈的调查方法，较以往研究更加完善了数据的全面性和代表性，能较好的反映公众对赋予公卫医师处方权的态度以及执业范围意向。调查发现近90%的人支持赋予公卫医师处方权，表明关键职业群体对赋予公卫医师处方权持有积极态度，展示了政策推动的潜力。目前相关省份试点工作具有以下共性：第一，选取部分基层医疗卫生机构作为试点单位；第二，对公卫医师处方权的获得严格把关，需经过培训考核合格后才能赋予相应领域的处方权；第三，选择整体风险可控的部分传染病（慢性传染病）、慢性病（高血压、糖尿病）、地方病等病种开展处方权试点。此外，部分省份结合自身实际情况展开创新性的尝试，例如海南省将患者复诊、预防接种、传染病预防性服药等纳入公卫医师处方权范围，重庆市将公卫医师处方行为纳入临床质量管理体系[12-15]。本研究调查结果印证了当前试点方案的科学性，具有可持续发展潜力。
3.2　公卫医师处方权执业范围应进一步完善
当前试点工作仅放开部分传染病处方权，这类传染病具有趋于慢性化、规范治疗以及需长期随访的特点，开放公卫医师对这类疾病的处方权能发挥公卫医师在随访管理方面的优势，也能更好地把控医疗质量。同时，传染病暴露后预防用药、针对传染病高危人群（例如前往传染病疫区的出国人员）的预防服药以及预防接种也应一同纳入执业范围，这对传染病的早期预防具有重要意义。在职业病方面，公卫医师大多局限于职业卫生监测与调查等日常工作，针对一些具有特效药或常规治疗方法的职业病、职业危害因素暴露后预防用药等并不具有处方权。本调查结果发现建议完全放开公卫医师对职业病诊疗处方权的比例仅稍低于慢性病、寄生虫和地方病。因此，后续的公卫医师处方权试点工作应考虑纳入职业病诊疗处方权，以发挥公卫医师在职业病防治方面的特殊职能，为职业群体提供更加全面的公共卫生服务。
3.3　非药物干预处方更能体现公卫医师的职能优势
相对于临床医师，公卫医师具有解决人群健康问题而不是个体诊疗的职业特点，因此健康干预或者非药物干预措施是其最为重要的手段。本研究发现绝大多数人认为应该允许公卫医师对慢性病患者和慢性病风险人群开具非药物干预的健康处方，充分体现了公众对慢性病防治认知水平的提升，也反映出非药物干预处方试行的可行性。非药物干预处方现在往往是以健康教育或者医嘱的形式出现，大众或患者缺乏执行力，不引起重视，进而无法发挥非药物干预的重要作用。有文献将非药物治疗方法解释为除药物之外的其他治疗方式，包括护理措施处方、营养处方、戒烟戒酒处方等等[16-19]。20世纪80年代初，我国引入了西方运动处方的概念和理论，在健身、慢性病防治等领域得到应用[20]。此外还有健康教育处方，可针对常见病、多发病或普遍意义的健康问题，为大众提供科学、规范、精准、有效的个体化健康教育服务[21-22]。与药物处方相比，非药物处方安全性较高，预防作用明显，更适合公卫医师处方权试行工作。然而，非药物干预处方要逐步试行推广还需法规和专业能力的保障。
3.4　公卫医师处方权胜任力是缓和基层现有矛盾的前提
基层是直接向群众提供基本服务的主要场所，然而现实却存在门诊量不足、硬件设备资源闲置、医生技术水平有限、服务内容单一等等问题，表现为“结构性过剩”与“功能性不足”[23-25]。因此，提高基层优质人力资源，实现供需匹配是优化基层医疗卫生服务的核心。基层公卫医师在疾病随访管理、综合干预等领域具有明显的专业优势，对慢性病、地方病及寄生虫病等整体风险可控的疾病能提供全方位、全周期的健康服务[26-27]，且基层公卫医师对慢病处方权开放的需求更加强烈，所以赋予公卫医师处方权可为群众提供更多元化的服务内容，还能一定程度上减轻基层全科医生医疗负担。
同时，鉴于基层公卫医师目前的职责定位、职业素养及专业能力现状[28]，后续应重点考虑以下方面：第一，借鉴临床医师培养模式和处方权赋予机制，大力推广公卫医师规范化培训[29]，以规培作为处方权赋予的前提条件，并且以公卫医师处方权胜任力为导向，改革规培培养模式；第二，强化公卫医师培训与考核，明确公卫医师处方权赋予机制，对处方权范围进行严格把控；第三，应参考现有的分级诊疗政策，分级分类开展公卫医师处方权工作，区（县）级疾控中心可作为公卫医师处方权从基层医疗机构向疾控中心的过渡，逐步开放不同疾病类型的诊疗处方权。同时，还应不断加强基层公卫人才队伍建设，增加关键岗位人员编制数量，加强基层与区（县）级机构的优势互补，提高公卫医师核心能力。
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2025年第52卷第12期
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doi: 10.20043/j.cnki.MPM.202409151
  • 接收时间：2024-09-09
  • 首发时间：2026-03-19
  • 出版时间：2025-06-25
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  • 收稿日期：2024-09-09
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    四川省疾病预防控制中心，四川 成都 610041

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刘玲玲，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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