对国内精神障碍临床指南的评价研究

发布时间：2018-02-11 18:05

本文关键词： 精神障碍指南指南研究与评价Ⅱ 评价应用实施　出处：《上海交通大学》2014年硕士论文　论文类型：学位论文

【摘要】：【目的】（1）评价国内精神障碍临床指南的方法学质量。（2）初步探索国内部分地区《精神分裂症防治指南》实施应用的现况。【方法】（1）检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文献数据库、PubMed及国内指南相关网站，并且结合同行专家建议辅以手动检索，收集国内精神障碍相关临床指南。按照预先制定的纳入、排除标准对检索结果予以筛选，对所获国内精神障碍临床指南，按照指南研究与评价（Appraisal of Guidelines for Research and Evaluation, AGREE）Ⅱ对其进行方法学质量评价。同时检索PubMed、BMJ Best Practice、Web of Science、DynaMed(EBSCO)等数据库，以及美国国家指南交换中心、英国国家卫生与临床优化研究院、苏格兰学院际指南网络、国际指南网络等指南网站，收集国外精神分裂症、焦虑障碍、心境障碍有关的临床指南，对其进行AGREEⅡ评价，并与国内此三类精神障碍临床指南作质量比较。（2）采用自编《精神分裂症防治指南》应用现况调查问卷，通过方便取样，在我国部分地区对临床一线精神科医师进行无记名问卷调查。【结果】(1)共获得15个符合纳入标准的国内精神障碍临床指南，其发表时间2006-2012年，开发组织主要为中华医学会。15个国内精神障碍临床指南AGREEⅡ各领域的中位数标准化得分显示，陈述清晰性（76%）及范围和目的(76%）领域最高；参与人员（41%）和应用性（40%）领域较低；开发严谨性（30%）和编辑独立性（3%）领域最低。国外临床指南的检索与筛选，共获得国外精神分裂症指南12个，焦虑障碍指南22个，心境障碍指南32个。12个精神分裂症指南，其6个领域的标准化得分中位数依次为92%、60%、70%、90%、31%、54%；22个焦虑障碍指南，6个领域标准化得分中位数分别为92%、53%、63%、88%、24%、46%；32个心境障碍指南，6个领域标准化得分中位数分别为86%、58%、61%、92%、24%、63%。精神分裂症、焦虑障碍、心境障碍有关指南国内、外比较，除应用性领域无统计学差异，其它5个领域国内指南得分均较国外指南低。（2）《精神分裂症防治指南》应用现况的调查，共回收问卷325份，有效问卷318份，有效率97.8%。81.1%调查医师表示知道该指南，其中读过指南的医师占72.1%（占总有效调查人数58.5%），读过的医师中96.2%在实践中参照指南，，且多数医师是部分参照。主要的指南实施阻碍因素：缺乏对指南的宣传（63.2%），缺乏对指南的理解（62.6%），多个指南之间缺乏共识、存在分歧（58.2%），缺乏与指南实施相适应的国家政策(54.7%)。促进指南实施的措施主要为：分发简易版指南（70.3%）、促进国家政策与指南相适应（55.5%）、利用地方医学会进行培训和推广（53.6%）。【结论】(1)国内精神障碍临床指南的方法学质量，总体上与AGREE Ⅱ标准相差较大，尤其编辑独立性、开发严谨性、应用性领域。今后国内精神障碍临床指南的开发或更新，需更多地参考AGREE Ⅱ。(2)国内部分地区《精神分裂症防治指南》的实施情况不理想，需采取全面措施促进指南的实施应用。
[Abstract]:[Objective] (1) to evaluate the methodological quality of the clinical guidelines for mental disorders in China. (2) to explore the current application of schizophrenia prevention and treatment guidelines in some areas of China.
[Methods] (1) Chinese retrieval knowledge resources database, Chinese journals database, Wanfang Data retrieval system, Chinese biomedical literature database, PubMed and guide domestic related websites, and with peer recommendations with manual retrieval, collection of domestic mental disorders. Clinical guidelines in accordance with pre established inclusion and exclusion criteria for retrieval results to the screening, the domestic mental disorders clinical guidelines for research and evaluation, in accordance with the guidelines (Appraisal of Guidelines for Research and Evaluation, AGREE) on the methodological quality evaluation. At the same time BMJ Best search PubMed, Practice, Web of Science, DynaMed (EBSCO) database, and the national guide exchange center the British National Institute for health and clinical excellence, Scotland Institute of international guide network, international network guide guide website, collect foreign schizophrenia, anxiety Disorder, mood disorder clinical guidelines on the evaluation of the AGREE II, and compare the quality and clinical guidelines of China the three types of mental disorders. (2) by using the self-designed "schizophrenia prevention guide > application status questionnaire by convenient sampling, an anonymous questionnaire survey was conducted on clinical psychiatrists in part area of our country.
[results] (1) received a total of 15 domestic clinical guidelines met the inclusion criteria of mental disorders, the publication time of 2006-2012 years, the main organization for the development of Chinese Medical Association in various fields.15 clinical guidelines for domestic mental disorders of AGREE median standardized score showed that a clear statement of scope and purpose (76%) and (76%) the highest in the field; (41%) and (40%) the application field is low; the development of rigor (30%) and editorial independence (3%). The lowest field retrieval and screening of foreign clinical guidelines, received a total of 12 foreign schizophrenia guidelines, anxiety disorders, mood disorders guide 22, guide 32.12 a guide to schizophrenia, the median standardized score in 6 areas were 92%, 60%, 70%, 90%, 31%, 54%; 22 anxiety disorder guide, 6 areas of standardization of the median score were 92%, 53%, 63%, 88%, 24%, 46%; 32 mood disorders guide, 6 collar Domain standard median score were 86%, 58%, 61%, 92%, 24%, 63%., schizophrenia, anxiety disorders, mood disorders related to guide domestic, outside, in addition to the application field of no significant difference, the other 5 areas to guide domestic scores compared with foreign guide low. (2) survey "schizophrenia the application of the guidelines for prevention and treatment", a total of 325 copies of questionnaires, 318 valid questionnaires, a survey of physicians know the efficiency of the 97.8%.81.1% guide, which read guide physicians accounted for 72.1% (the total number of research, 58.5%) 96.2% read physicians in practice according to guidelines, and most physicians are part of the reference. The main factors hindering the implementation of guidelines: lack of publicity guide (63.2%), lack of understanding of the guide (62.6%), a lack of consensus among a plurality of guide, there are differences (58.2%), and the lack of implementation guidelines to adapt to the national policy (54.7%). A Guide to promoting the implementation of the measures The main features are: the distribution of simple guide (70.3%), the promotion of national policies and guidelines (55.5%), and the use of local medical societies for training and promotion (53.6%).
[Conclusion] (1) methods clinical guidelines for mental disorders domestic quality, with the overall AGREE II standard difference, especially the development of editorial independence, rigor, application fields. The future domestic clinical guidelines of mental disorders developed or updated, need more reference AGREE II. (2) the implementation of the spirit of parts < > split guide domestic disease control is not ideal, need to take comprehensive measures to promote the implementation of the application guidelines.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749

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