真菌感染患者对伏立康唑个体化用药的意愿调查

发布时间：2018-07-27 18:06

【摘要】：目的了解患者对伏立康唑个体化用药的认知与意愿,探讨参与临床决策时患者的考虑因素,为伏立康唑个体化用药指南的推荐强度的形成提供依据。方法用横断面研究方法,通过问卷的形式在9家医院调查不同类型患者对于伏立康唑治疗药物监测(TDM)及细胞色素2C19(CYP2C19)基因型检测的认知与意愿。结果本研究共纳入119例患者,其中有24例(20.17%)儿童。95例(79.83%)患者认为在治疗真菌感染期间有必要进行伏立康唑TDM,曾经接受过伏立康唑TDM与没有接受过的患者对于接受伏立康唑TDM的意愿存在显著差异(100%vs 75.76%,P0.05)。有54例(45.38%)患者愿意进行CYP2C19基因型检测,不同医保类型的患者存在显著性差异(P0.05)。对于患者做出以上2个决策的影响因素排序均有统计学上的一致性(P0.05),临床有效性均是患者最为看重的因素(秩均值3.46∶3.87),花费(秩均值1.89)和潜在获益(秩均值2.00)分别为伏立康唑TDM和CYP2C19基因型检测对患者临床决策影响最小的因素。结论不同真菌感染患者对伏立康唑TDM及CYP2C19基因型检测的意愿存在较大差异。其可能是临床医师做临床决策的一个重要因素。在临床指南的建立和临床实践过程中应考虑患者的认知与意愿。
[Abstract]:Objective to understand the cognition and willingness of patients with individual use of fulconazole, and to explore the factors that may be taken into account in clinical decision making so as to provide the basis for the formation of the recommended strength of the guidelines for individual use of voriconazole. Methods A cross-sectional study was conducted to investigate the cognition and willingness of different types of patients to monitor (TDM) and cytochrome 2C19 (CYP2C19) genotypes in 9 hospitals by means of a cross-sectional study. Results 119 patients were included in this study. Among them, 24 (20.17%) children. 95 (79.83%) patients considered it necessary to take Volconazole TDM during the treatment of fungal infection. There was significant difference in the willingness of patients who had received TDM and those who had not (100%vs 75.76P). There were 54 patients (45.38%) willing to be tested for CYP2C19 genotypes, and there were significant differences among the patients with different types of medical insurance (P0.05). The order of influencing factors for the above two decisions was statistically consistent (P0.05). Clinical effectiveness was the most important factor (rank average 3.46: 3.87), cost (rank average 1.89) and potential gain (rank average 2.00). Volconazole TDM and CYP2C19 genotypes were the least influential factors in clinical decision-making. Conclusion the willingness to detect TDM and CYP2C19 genotypes in patients with different fungal infections was significantly different. It may be an important factor for clinicians to make clinical decisions. Patients' cognition and willingness should be taken into account in the establishment of clinical guidelines and clinical practice.
【作者单位】：北京大学第三医院药剂科;北京大学药学院药事管理与临床药学系;中国医科大学盛京医院药剂科;西安交通大学附属第一医院药剂科;中南大学湘雅二医院药剂科;宁波大学医学院附属医院药剂科;玉林市红十字会医院药剂科;北京友谊医院药剂科;山西省肿瘤医院药剂科;北京大学人民医院药剂科;
【分类号】：R978.5

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