摘要
目的探讨在实践中评价临床实践指南开发质量的科学方法,对社区转诊指南的质量和临床效果进行科学评价。方法采用问卷调查法对北京市城区和远郊区各一个区内试用转诊指南的社区医生进行调查,就指南的质量和效果进行测评。采用"全面性、可理解性、严谨性、清晰性、适宜性、必要性、实施阻碍因素"等作为指南质量评价指标,采用"对专业知识的帮助、对减少误诊漏诊的帮助、对减少过度转诊的帮助"作为效果评价指标。采用百分率、2χ检验、秩和检验、回归分析等统计方法分析指南的质量和效果及影响指南效果的因素。结果共回收合格问卷160份,包括宣武区60份、顺义区100份。试用期间,社区医生对转诊指南进行了一定的使用。大多数社区医生对指南的质量和效果持肯定态度。在对专业知识的帮助方面,转诊指南对较低职称的社区医生帮助更大;在减少过度转诊方面,转诊指南对远郊区县的社区医生,从事专业年限较短的社区医生,乡村医生、医士、助理医师、无职称的社区医生取得了更明显的效果。指南全面性、适宜性指标与减少过度转诊指标存在定量关系。结论应重视社区临床指南的开发与试用评价。评价方法采用调查问卷的方式,采取质量和效果有关指标进行评价是可行的。为保证实施效果,今后开发社区指南时应该更加注意指南的全面性和适宜性。
Objective To test a scientific method for assessing clinical practice guidelines in primary care so as to scientifically evaluate the quality of community referral guidelines and clinical efficacy.Methods A questionnaire survey was taken among general practitioners from a community in the urban areas and one from suburb areas of Beijing,where the referral guidelines was on trial,about the quality and efficacy of the guidelines.The indexes assessing quality included comprehensiveness,being understood,preciseness,clarity,fitness,necessity,and hindering factor in implementation;and the indexes assessing efficacy were being beneficial for professional knowledge,for reducing misdiagnosis and missed diagnosis,and for reducing excessive referral.Some statistic methods including percentage,χ2 test,H test,and Logistic regression analysis were taken treatment of the quality,efficacy and influencing factors on its effect.Results Totally 160 qualified questionnaires（60 from Xuanwu district and 100 from Shunyi district） were obtained.The general practitioners had applied the guidelines in the trial period.Most general practitioners had approved the quality and effect of the guidelines.The general practitioners with lower professional titles had received more help of special knowledge.In reducing excessive referral the guidelines had gave more help to those practitioners form suburb areas,with shorter period of specialized work,from rural areas,or healers,medical assistants,or those with no professional title.The mark of reducing excessive referral was varying with the marks of comprehensiveness and fitness.Conclusion More attention should be paid to assessment of development and application of the community clinical guidelines.It is feasible for assessment to apply questionnaire survey and relevant indexes of quality and efficacy.To ensure the implementation effect the comprehensiveness and fitness should be emphasized in future development of community guidelines.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第10期1063-1065,1072,共4页
Chinese General Practice
基金
国家科技支撑计划《社区疾病预防与控制研究》重点项目:《社区基层卫生服务信息技术研究》(2007BAI24B07)
北京市哲学社会科学规划项目:《北京市社区常见疾病症状与体征的转诊指征和转诊优先级的研究》(08BdSH042)
关键词
社区
转诊
实践指南
试用研究
Community
Referral
Practice guidelines
Pilot study
