北京地区医生痛风诊疗认知现状的初步研究

发布时间：2018-02-02 00:10

本文关键词： 痛风医生问卷调查　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：背景:近年关于痛风的机制、诊断和治疗方面的研究不断有新的进展,但痛风的治疗效果却没有明显改善。国外的调查显示医生存在痛风评估不足、急性期止痛和降尿酸药物使用不规范、治疗时间不足、患者依从性差等问题。随着我国分级诊疗制度的推广,未来慢性病主要由社区医生管理,因此了解我国医生特别是社区医生对痛风的诊治现状十分必要。目的:通过对北京市9个城区的医生进行现场问卷调查,了解北京市医生对痛风的认知现状,以便为其提供更加针对性的继续教育,提高痛风管理水平。方法:结合北京市卫生科技成果和适宜技术推广项目《高尿酸血症社区管理规范推广》,对参加项目培训的医生现场进行痛风知识问卷(Gout related Knowledge Questionnaire,GKQ)调查(10个问题,每答对1题得1分),同时收集答卷人的个人资料,包括年龄、性别、工作年限、职称、学历、专业、每年接诊痛风和高尿酸血症患者数目、对痛风和高尿酸血症诊断及治疗的了解程度、每年接受痛风和高尿酸血症继续教育次数、所在单位具备的降尿酸药物和痛风相关的辅助检查方法。分别计算平均值±标准差或百分比,采用卡方或t检验进行比较,单因素和多因素回归分析影响痛风认知现状的相关因素。结果:共发放298份问卷,收回298份,有效问卷250份,其中127份来自社区服务中心医生(社区医生),123份来自三级医院医生。分析结果发现,65.1%的社区卫生服务中心无降尿酸药物,75.0%未开展痛风相关影像学或穿刺液检查,均显著低于三级医院相应比例(p0.01)。社区医生和三级医院医生平均答题正确数分别为6.6±1.9题、7.2±2.0题(P=0.026)。在痛风发病原因、病理学机制和临床表现上答题正确率,两组均在70%以上,其中发病原因正确率接近100%。而在急性痛风性关节炎的治疗方面,两组均只有50%左右的医生选择NSAIDs止痛治疗;具有降低血尿酸作用的药物方面,两组仍有46.3%和32.2%的医生选择秋水仙碱;关于降尿酸治疗时间,只有40.5%的社区医生和57.6%的三级医院医生认为应长期治疗(p=0.007);两组均只有60%左右的医生知晓高血压为痛风的常见合并疾病。单因素Logistic回归分析发现继续教育是影响痛风诊疗规范知晓的因素。结论:目前社区医生对痛风的基本概念了解程度较高,但在诊疗规范方面(如急性期治疗、降尿酸药物、治疗时间等)尚有不足,未来应加强对社区医生痛风治疗方面的继续教育。
[Abstract]:Background: recent studies on the mechanism, diagnosis and treatment of gout have made great progress, but the therapeutic effect of gout has not been improved significantly. Acute pain relief and uric acid drug use is not standardized, treatment time is insufficient, patient compliance is poor. With the promotion of the classification system of diagnosis and treatment in China, chronic diseases will be managed by community doctors in the future. Therefore, it is necessary to understand the status quo of the diagnosis and treatment of gout among Chinese doctors, especially the community doctors. Objective: to investigate the status of cognition of gout among doctors in 9 urban areas of Beijing through a questionnaire survey. In order to provide more targeted continuing education and improve the gout management level. Methods: combined with Beijing health science and technology achievements and appropriate technology extension project "hyperuricemia community management standard promotion". Gout related Knowledge Questionnaire was used to investigate the gout knowledge of doctors who participated in the project training. GKQ) Survey (10 questions, 1 score for each correct question, while collecting personal data of respondents, including age, sex, length of work, title, education, major. The number of patients with gout and hyperuricemia received each year, the degree of understanding of diagnosis and treatment of gout and hyperuricemia, and the number of times of continuing education on gout and hyperuricemia each year. To calculate the mean 卤standard deviation or percentage, and compare it with chi-square or t test. Results: 298 questionnaires were issued, 298 were collected and 250 were valid. Among them, 127 were from community service center doctors (123 from tertiary hospitals). The results showed that 65.1% of community health service centers had no antiuric acid drugs. 75.0% no gout related imaging or puncture fluid examination was performed. The average number of correct answers of community doctors and doctors in tertiary hospitals was 6.6 卤1.9, respectively. The correct rate of answering questions in the pathogenesis, pathological mechanism and clinical manifestation of gout was above 70% in both groups. In the treatment of acute gouty arthritis, only about 50% doctors in both groups chose NSAIDs to relieve pain. With regard to drugs that reduce uric acid, 46.3% and 32.2% doctors in the two groups still chose colchicine; Only 40.5% of the community doctors and 57.6% of the third class hospital doctors think that long-term treatment should be given to reduce uric acid treatment time, only 40.5% of the community doctors and 57.6% of the doctors in the third class hospital think that long-term treatment should be given. Only about 60% doctors in both groups knew that hypertension was a common complicated disease of gout. Univariate Logistic regression analysis showed that continuing education was the factor affecting the knowledge of gout diagnosis and treatment norms. At present, community doctors have a better understanding of the basic concept of gout. However, there are still deficiencies in the standard of diagnosis and treatment (such as acute stage treatment, uric acid lowering drugs, treatment time, etc.). Further education on gout treatment for community doctors should be strengthened in the future.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7

【相似文献】