杭州市拱墅区社区医护人员循证医学培训效果分析

发布时间：2018-03-25 04:33

本文选题：循证医学　切入点：教学模式　出处：《浙江中医药大学》2017年硕士论文

【摘要】：目的探讨一种针对社区医护人员的循证医疗培训方案,并采用循证医疗知识、态度、运用、预期使用(Evidence-Based Practice-knowledge,attitude,application,anticipated future use,EBP-KAPF)自我评估量表和社区高血压规范化防治EBP自制量表评价该培训方案的效果,为全科医生开展循证医疗培训提供数据。方法召集杭州市拱墅区2个社区卫生服务中心的医护人员共151人,以社区中心为小组,随机分为试验组(米市巷街道社区卫生服务中心,n=69)和对照组(小河湖墅街道社区卫生服务中心,n=82)。试验组采用多种授课形式结合的综合性教学形式授予医护人员EBP理论知识、循证医疗技能(提出临床问题、文献检索、证据评价、证据运用、后效评价)、EBP案例讨论等课程,对照组医护人员采用网络自学形式自主学习相同课程内容。两组均接受为期8周,每周1次,每次2学时,共16学时的循证医学培训课程。培训前后两组均接受EBP-KAPF量表的基线评估和干预后评估,以及自制EBP量表的干预后评估。本次研究通过SPSS17.0统计软件进行结果分析。结果1.培训前组间分层情况比较:两组在性别构成比、职称构成比、医护构成比、中西医构成比方面较一致,差异无统计学意义(P0.05)。2.培训前组间EBP-KAPF四项总分比较:两组EBP-K、EBP-A、EBP-P、EBP-F四项总分较一致,差异无统计学意义(P0.05)。3.培训前后组内EBP-KAPF四项总分比较:试验组EBP-K、EBP-P、EBP-F三项总分均较培训前提高,差异均有统计学意义(P0.05),EBP-A总分较培训前降低,差异有统计学意义(P0.05),对照组在培训前后四项总分较一致,差异无统计学意义(P0.05)。4.培训后组间EBP-KAPF四项总分比较:试验组EBP-K、EBP-P、EBP-F三项总分均较对照组高,差异均有统计学意义(P0.05),EBP-A总分较培训前低,差异有统计学意义(P0.05);且培训后,试验组EBP-K、EBP-A、EBP-P、EBP-F四项总分百分比变化均较对照组提高,差异有统计学意义(P0.05)。5.培训后组内EBP-KAPF四项总分分层比较:不同性别、不同职称、医护之间、中西医之间EBP-K、EBP-A、EBP-P、EBP-F四项总分较一致,差异无统计学意义(P0.05)。6.培训后组间自制EBP量表评估比较:主观性部分试验组总分较对照组高,差异具有显著性(P0.05),客观性比较组间差异无显著性(P0.05)。结论1.多种授课形式结合的综合性循证医疗培训方案能有效改善社区医护人员循证医疗知识(EBP-K)、态度(EBP-A)、运用(EBP-P)、预期使用(EBP-F)的认知。2.多种授课形式结合的综合性EBP培训方案较网络自学更能提高社区医生临床实践自信度。3.受限于社区医护人员自身专业能力、时间等因素,网络自学形式难以达到理想的EBP培训效果。4.根据培训对象进行科学制定EBP培训课程,使培训课程更具适用性,从而提高EBP培训效果。5.根据EBP培训目的选择合适的评价工具有助于客观反映培训效果。6.针对社区医护人员的循证医学培训方案的推广有待进一步验证。
[Abstract]:Objective to explore a kind of evidence-based medical training program for community health care personnel, and adopt evidence-based medical knowledge, attitude and application. The Evidence-Based practice knowledge (Evidence-Based practice knowledge) self-assessment scale (Evidence-Based practice knowledge) (Evidence-Based practice knowledge) (Evidence-Based practice knowledge) (Evidence-Based practice) self-assessment scale (EBP-KAPF) and the EBP self-made scale for the standardized prevention and treatment of hypertension in the community were expected to be used. Methods 151 medical staff from 2 community health service centers in Gongshu District, Hangzhou City, were convened, and the community center was used as a group. The experimental group was randomly divided into two groups: the experimental group (Mishi Xiang street community health service center) and the control group (Xiaohe Hu Shu street community health service center). The experimental group adopted a comprehensive teaching method combined with various teaching methods to grant medical and nursing staff EBP theoretical knowledge. Evidence-based medical skills (presentation of clinical questions, literature retrieval, evidence evaluation, evidence use, after-effect evaluation, EBP case discussion, etc.), In the control group, the medical and nursing staff independently studied the same course in the form of self-study on the Internet. The two groups received two hours of study once a week for 8 weeks. A total of 16 hours of evidence-based medicine training courses. Both groups received baseline assessment and post-intervention assessment of EBP-KAPF scale before and after training. The results of this study were analyzed by SPSS17.0 statistical software. Results 1. Comparison of the stratification of the two groups before training: the sex composition ratio, the professional title ratio, the medical care composition ratio, the sex composition ratio, the professional title composition ratio, the medical care composition ratio between the two groups; 2. The composition ratio of traditional Chinese and western medicine was the same, and the difference was not statistically significant (P 0.05). 2. Comparison of the four total scores of EBP-KAPF between groups before training: the four total scores of EBP-Ku EBP-Agna EBP-PnP and EBP-F were the same in the two groups. Before and after training, the total scores of EBP-KAPF in the test group were higher than those before and after training, and the total scores of EBP-A in the test group were lower than those before training. The difference was statistically significant (P 0.05), the total scores of four items in the control group were the same before and after training, but the difference was not statistically significant (P 0.05). After training, the total scores of four items of EBP-KAPF in the experimental group were higher than those in the control group, and the total scores of three items in the test group were higher than those in the control group. The total score of EBP-A was significantly lower than that of before training, and the percentage of total scores of EBP-Ku EBP-An EBP-PnP in the experimental group was higher than that of the control group after training. After training, the four total scores of EBP-KAPF in the training group were compared: the total scores of the four items EBP-K, EBP-An, EBP-PnP and EBP-F were the same among different gender, different title, medical care, and traditional Chinese and western medicine, and the difference was significant (P < 0.05) after training, the total scores of EBP-P and EBP-F in the training group were the same. There was no significant difference between the two groups (P 0.05). The comparison of self-made EBP scale after training: the total score of subjective part of the trial group was higher than that of the control group. The difference is significant (P 0.05), but there is no significant difference in objectivity among groups. Conclusion 1. The comprehensive evidence-based medical training program combined with various teaching forms can effectively improve the EBP-K knowledge, attitude of EBP-An, use EBP-P0. The comprehensive EBP training program combined with various teaching forms can improve the community doctors' confidence in clinical practice. 3. Limited by the professional ability of community health care workers, the comprehensive EBP training program can improve the clinical practice confidence of community doctors. Time and other factors, network self-learning form is difficult to achieve the ideal EBP training effect .4.According to the training object to scientifically formulate the EBP training course, make the training course more applicable. Therefore, to improve the effect of EBP training .5.The selection of appropriate evaluation tools according to the purpose of EBP training is helpful to objectively reflect the training effect .6.The promotion of evidence-based medicine training program for community health care personnel needs to be further verified.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R-4;C975

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