【作者】 陈曦；

【导师】 付守芝； 朱书秀；

【作者基本信息】 江汉大学 ， 全科医学， 2023， 硕士

【摘要】 研究背景及目的:血脂异常是社区居民中常见慢病之一。全科医师作为基层医疗的重要组成部分,为社区血脂异常患者提供的基层管理服务。血脂达标率很大程度上取决于全科医师对调脂药合理应用的情况。因此,本研究通过问卷调查的方法,以武汉市全科医师为研究对象,深入了解全科医师对于调脂治疗合理用药的认知现状及其相关影响因素,旨在为规范全科医师药品的使用与居民血脂管理提供参考和借鉴。方法:本研究采用理论研究和实证研究相结合的方法。通过文献研究法,收集国内外有关调脂药应用的相关治疗指南及学术论文等资料,并且对其进行文献研究。通过问卷调查法,了解武汉市全科医师对调脂治疗合理用药的认知现状及其相关影响因素,并根据不同级别的医疗单位,对影响因素分别进行Poisson回归分析。结果:1.社区卫生服务中心和三级综合医院两组间全科医生的学历、继教学习情况、获取医学信息途径存在统计学差异(P<0.05);全科医生的性别、年龄、专业职称、临床药师参与情况、从事全科医疗工作年限、每日门诊接诊病人量、接诊的患者群体中血脂异常的大致比例等方面无统计学差异(P>0.05)。2.在血脂异常合理用药遴选题目方面,正确率最高的是考察药物服用时间的第九题,共123例(89.1%)回答正确;正确率最低的是考察不同调脂药物降脂强度的第七题,共42例(30.4%)回答正确,且社区卫生服务中心和三级综合医院的全科医生在调脂治疗合理用药的遴选题目的得分上有差异(P<0.05)。3.在社区医院的全科医生样本中,以全科医生的得分情况作为因变量,将单因素分析的结果中P<0.05的变量进行Poisson回归分析,结果显示相对于近一年继教学习次数达3次及以上的社区全科医生来说,继教学习次数为0次、1次、2次的全科医生得分更低(P<0.001,RR=0.592,95%CI:0.519-0.677)、(P<0.001,RR=0.626,95%CI:0.530-0.741)、(P<0.001,RR=0.701,95%CI:0.576-0.852);相对于接诊患者量>60人/日的全科医生来说,接诊患者量为30-60人/日的全科医生得分更低(P<0.05,RR=0.824,95%CI:0.709-0.957)。4.在三级医院的全科医生样本中,以全科医生的得分情况作为因变量,将单因素分析的结果中P<0.05的变量进行Poisson回归分析,结果显示相对于接诊患者中血脂异常比例≤25%的全科医生来说,接诊患者中血脂异常比例为25%-50%和50%-75%的全科医生得分更高(P<0.001,RR=1.418,95%CI:1.180-1.704)、(P<0.001,RR=1.589,95%CI:1.320-1.912)。结论:武汉市中心城区的全科医生对于调脂治疗合理用药的认知水平普遍较低,尤其体现在对调脂药物不同剂量相对应的作用强度认知上。其中社区卫生服务中心的全科医生对于调脂治疗合理用药的认知水平低于三级综合医院的全科医生。可以有针对性地开展血脂异常相关主题学习、增加年轻医生接触血脂异常患者的实践机会来提高全科医生对调脂治疗合理用药的认知水平。更多还原

【Abstract】 Background and objective: Dyslipidemia is one of the common chronic diseases in community residents.As an important part of primary care,general practitioners provide grass-roots management services for patients with dyslipidemia in the community.The rate of reaching the standard of blood lipids largely depends on the rational use of lipid-regulating drugs by general practitioners.Therefore,through the method of questionnaire survey,this study takes the general practitioners in Wuhan as the research object to deeply understand the cognitive status of general practitioners on the rational use of drugs in lipid-lowering therapy and its related influencing factors.the purpose of this study is to provide reference for standardizing the drug use of general practitioners and the management of blood lipids in residents.Methods: This study adopts the method of combining theoretical research with empirical research.Through the method of literature research,the relevant treatment guidelines and academic papers about the application of lipid-regulating drugs at home and abroad were collected,and the literature was studied.Through the questionnaire survey,to understand the cognitive status of Wuhan general practitioners on the rational use of drugs and its related factors,and according to different levels of medical units,the influencing factors were analyzed by Poisson regression.Results:1.There were significant differences in general practitioners’ education,learning and access to medical information between the community health service center and the tertiary general hospital(P < 0.05).There were no statistical differences in gender,age,professional title,participation of clinical pharmacists,working years of general practice,the number of patients per day in outpatient service,and the proportion of dyslipidemia in the group of patients(P > 0.05).2.In terms of the selection of rational drug use for dyslipidemia,the question with the highest correct rate was the ninth question on the time of drug use,which was answered correctly in 123 cases(89.1%).The lowest correct rate was the seventh question on the intensity of different lipid-lowering drugs,which was answered correctly in 42 cases(30.4%).And there were differences in the scores of general practitioners in the selection of lipid-regulating treatment and rational use of drugs between community health service centers and tertiary general hospitals(P < 0.05).3.In the sample of general practitioners in community hospitals,the scores of general practitioners were taken as dependent variables,and the variables in the results of univariate analysis were analyzed by Poisson regression analysis.the results showed that the scores of general practitioners with learning times of 0,1 and 2 were lower than those of community general practitioners with learning times of 3 or more times in the past year(P<0.001,RR=0.592,95%CI:0.519-0.677)、(P<0.001,RR=0.626,95%CI:0.530-0.741)、(P<0.001,RR=0.701,95%CI:0.576-0.852).Compared with general practitioners with more than 60 patients per day,general practitioners with 30 to 60 patients per day had lower scores(P<0.05,RR=0.824,95%CI:0.709-0.957).4.In the sample of general practitioners in tertiary hospitals,the scores of general practitioners were taken as dependent variables,and the variables in the results of univariate analysis were analyzed by Poisson regression analysis.the results showed that the general practitioners with the proportion of dyslipidemia ≤ 25% had higher scores than those with dyslipidemia of 25%-50% and 50%-75%(P<0.001,RR=1.418,95%CI:1.180-1.704)、(P<0.001,RR=1.589,95%CI:1.320-1.912).Conclusion:The cognitive level of general practitioners in the central urban area of Wuhan for the rational use of lipid-lowering drugs is generally low,especially reflected in the cognition of the corresponding action intensity of different doses of lipid-regulating drugs.Among them,the cognitive level of general practitioners in community health service centers on the rational use of lipids is lower than that of general practitioners in tertiary general hospitals.We can pertinently carry out the study of topics related to dyslipidemia and increase the practical opportunities for young doctors to contact patients with dyslipidemia to improve the cognitive level of general practitioners on the rational use of drugs in lipid-regulating therapy.更多还原