摘要
目的 对社区全科医生在多病共存患者潜在不合理用药情况进行调研,探讨提升策略。方法 对本项目组前期研究检验出社区潜在不合理用药(PIM)项目21项设计田野调查问卷。于2021年12月—2022年1月使用机械式抽样方法对上海市浦东新区47家社区卫生服务中心在岗的236名全科医生抽取共计1 500张处方,并进行在线问卷调研。结果 21项PIM出现频率最高的项目为“地高辛用于心室收缩功能正常的心力衰竭患者”“使用袢利尿剂治疗无心力衰竭临床表现的依赖性踝部水肿”等,对PIM条目的主观出现频率判断、全科医生的主观合理性判断、处方中实际出现客观频率进行两两差异性分析,秩和检验提示:21项潜在不合理用药条目主观合理性判断和客观出现频率相比,差异均有统计学意义(P<0.05);21项潜在不合理用药条目主观出现频率判断和主观合理性判断相比,除“硝苯地平常释剂型作为降压药物”条目二者差异无统计学意义(P>0.05),其余条目差异均有统计学意义(P<0.01);以21个PIM的日常出现频率评估为因变量,以职称、学历等5个因素作为自变量进行线性回归分析,结果显示各因素均非PIM日常出现频率的影响因素(P>0.05)。结论 目前家庭医生对多重慢病患者的潜在不合理用药尚缺乏主观认知,且较为普遍,应开展统一培训指导。
Objective To investigate the potential irrational drug use among community general practitioners in patients with multimorbidity diseases,and explore improvement strategies.Methods Twenty-one field research questionnaires of community potentially inappropriate medications(PIM)project were tested in the previous study of this project group.A total of 1500 prescriptions were collected from^(2)36 general practitioners on duty at 47 community health service centers from December 2021 to January 2022 in Pudong New Area,Shanghai using mechanical sampling method,and an online questionnaire survey was conducted.Results The 21 items with the highest frequency of PIM were"Digoxin for heart failure patients with normal ventricular systolic function","ankle edema dependent on clinical manifestations of non-heart failure treated with loop Diuretic",etc.The difference analysis was made on the subjective frequency of PIM items,the subjective rationality judgment of general practitioners,and the actual objective frequency in prescriptions.The rank sum test suggested that there was a statistically significant difference between the subjective rationality judgment and objective occurrence frequency of 21 potentially irrational drug use items(P<0.05);Compared with the subjective frequency judgment and subjective rationality judgment of 21 potential irrational drug use items,there was no significant difference between the two items except for the item"Nifedipine regular release dosage form as antihypertensive drug"(P>0.05),and the other items had significant differences(P<0.01);Linear regression analysis was conducted using the daily occurrence frequency of 21 PIMs as the dependent variable and 5 factors such as professional title and education as independent variables.The results showed that each factor had no significant impact on the daily occurrence frequency of PIMs(P>0.05).Conclusion Currently,family doctors lack subjective understanding of the potential irrational use of medication in patients with multiple chronic diseases,a
作者
黄倩
徐昕
邵洁
张芳
朱敏
周路路
张胜冰
黄蛟灵
刘葳
HUANG Qian;XU Xin;SHAO Jie;ZHANG Fang;ZHU Min;ZHOU Lulu;ZHANG Shengbing;HUANG Jiaoling;LIU Wei(Weifang Community Health Service Center,Pudong New Area,Shanghai 200122,China;不详)
出处
《中华全科医学》
2024年第1期93-96,143,共5页
Chinese Journal of General Practice
基金
上海市浦东新区卫健委学科带头人培养计划项目(PWRd2021-08)
上海市浦东新区科技发展基金民生科研专项资金项目(PKJ2019-Y48)
上海市“医苑新星”青年医学人才培养资助计划项目(沪卫人事[2022]65号)。
关键词
共存病
不合理用药
培训
需求
家庭医生
Multimorbidity
Irrational drug use
Training
Needs
Family doctor
