摘要
背景高血压是严重危害人群健康的常见慢性病,基层医生是高血压管理的主力军,而医源性治疗惰性在很大程度上影响了基层高血压控制的达标情况。目的调查基层医生在高血压诊疗过程中的治疗惰性,并分析治疗惰性成因,为提高我国高血压控制率提供参照依据。方法采用简单随机抽样法,于2023年7—8月向天津市32家基层医疗卫生机构的基层医生发放调查问卷,从“软理由”“高估治疗效果”“医保政策”3个维度评价基层医生在高血压诊疗过程中的治疗惰性,采用二元Logistic回归分析探究治疗惰性的影响因素。结果本研究共发放问卷407份,回收有效问卷386份,有效回收率94.84%。基层医生高血压诊疗知识得分为6(0.5)分,得分率为61.11%(5.50/9.00);高血压治疗惰性总得分为48(7.0)分,得分率为56.55%(45.24/80.00)。“软理由”维度得分为26(4.8)分,得分率为51.92%(25.96/50.00);“高估治疗效果”维度得分为10(2.0)分,得分率为65.40%(9.81/15.00);“医保政策”维度得分为6(2.5)分,得分率为46.40%(6.96/15.00)。3个维度治疗条目水平得分比较,“高估治疗效果”维度得分相较于其他两组得分最高(P<0.05)。多因素分析显示,性别、地区、高血压诊疗知识掌握程度及每日接诊高血压患者数是基层医生治疗惰性发生的主要影响因素(P<0.05)。结论基层医生在高血压诊疗过程中普遍存在治疗惰性,高血压诊疗认知水平较低、“高估治疗效果”和“软理由”是导致基层医生在高血压诊疗过程中存在治疗惰性的主要因素。建议加强针对高血压治疗惰性的教育,开展多样化的诊疗知识及管理培训,同时推行临床信息化和人工智能决策系统,或可有效改善基层医生的高血压治疗惰性。
Background Hypertension is a common chronic disease that seriously endangers the health of the population.The primary-care doctors are the main force in the management of hypertension.However,the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control.Objective The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension,and analyze the causes of therapeutic inertia,providing a reference basis for improving hypertension control rates in China.Methods A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023.The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions:"soft reasons"and"overestimation of treatment efficacy"as well as"medical insurance policies".Binary Logistic regression analysis was employed to explore the influencing factors of therapeutic inertia.Results A total of 407 questionnaires were distributed in this study,and 386 valid questionnaires were collected,yielding an effective response rate of 94.84%.The average score for primary healthcare providers'knowledge of hypertension diagnosis and treatment was 6(0.5),with a scoring rate of 61.11%(5.50/9.00).The total score for therapeutic inertia in hypertension management was 48(7.0),with a scoring rate of 56.55%(45.24/80.00).The scores for the"soft reasons"dimension,"overestimation of treatment efficacy"dimension,and"medical insurance policies"dimension were 26(4.8),10(2.0),and 6(2.5)respectively,with scoring rates of 51.92%(25.96/50.00),65.40%(9.81/15.00),and 46.40%(6.96/15.00)respectively.When comparing the average scores of the three dimensions of therapeutic inertia,the"overestimation of treatment efficacy"dimension had the highest score compared to the other two groups(P<0.05).Multivariate analysis indicated that ge
作者
王雪竹
魏婷婷
刘沛
潘立平
刘莹
边波
WANG Xuezhu;WEI Tingting;LIU Pei;PAN Liping;LIU Ying;BIAN Bo(Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300000,China;Department of General Practice,Tianjin Medical University General Hospital,Tianjin 300000,China)
出处
《中国全科医学》
CAS
北大核心
2024年第34期4273-4279,共7页
Chinese General Practice
基金
天津市卫生健康科技项目(TJW2023XK002)。
关键词
高血压
社区管理
基层医生
医生认知
治疗惰性
天津
Hypertension
Community management
Primary care doctors
Physician cognition
Therapeutic inertia
Tianjin
