急性ST段抬高心肌梗死临床指南知晓率及应用情况调查

A survey on cardiologists' knowledge and attitudes towards ST-elevation myocardial infarction guidelines in China

目的:调查我国心内科医生对急性ST段抬高心肌梗死(STEMI)临床指南的了解与使用情况,为促进指南执行提出具体建议。方法:采用不记名问卷形式,对我国部分省市310名心内科医生进行调查。结果:绝大多数被访者认为,需要临床指南(99.0%)及中国临床指南(94.5%),参考美国心脏病学会2004年临床指南的人数最多,占58.5%,对其知晓和认可情况在三级甲等医院和其他医院间差异无显著性,14.0%主要参考中国现有指南。知识得分及格率三甲医院为75.0%,其他医院64.4%,其差异与医生的学历有关(β=0.127,s=0.036,sβ=0.201,P=0.001)。被访医生主要(52.4%)使用大开本印刷版形式的临床指南,常用数据库为美国心脏病学会/美国心脏病协会(ACC/AHA)指南库(34.2%)和MEDLINE(32.6%),96.7%希望建立中国指南数据库以便获取指南信息。阻碍指南执行的因素集中于“患者依从性差”(51.8%)、“医生对指南内容不清楚”(49.2%)以及“费用因素”(47.9%),“加强医生教育”(82.1%)、“精简指南使其建议突出”(69.7%)和“加强患者教育”(53.1%)可能有助于促进临床指南的进一步执行。结论:应积极更新中国心肌梗死临床指南,建立中国指南数据库,加强医生与患者教育,促进指南执行。

Objective：To investigate the knowledge and attitudes towards ST-elevation myocardial infarction guidelines among Chinese cardiologists and give some recommendations for dissemination and implement of clinical guidelines. Method： An anonymous questionnaire was administered to 310 cardiologists from 15 provinces in China. Result：Almost all of the interviewees （99.0%） stated that clinical guidelines were needed either to a major or moderate extent, and 94.5% believed they needed native guidelines. However, only 14.0% claimed implementing current Chinese myocardial infarction guideline. Most cardiologists （58.5%） selected the guideline developed by American College of Cardiology/American Heart Association in 2004 to helop making clinical decisions. There is no statistically significant difference of the awareness and acceptance between hospitals of grade A class Ⅲ and others. The pass rate of the examination is 75.0% and 64.4% in hospitals of grade A class Ⅲ and others respectively,the doctors＇ degree should account for the difference （ β = 0.127, s = 0.036, sβ = 0.201, P - 0.001 ）. When using a guideline,a majority （52.4%） selected the book edition as the fagvorite form. And 96.7% believed they need a Chinese guideline databhase to achieve more guideline information. Key barriers to greater implementation of guidelines were seen as patient compliance （51.8%）,lack of guideline knowledge among doctors （49.2%）, and prescription costs （47.9）. Suggestions for ways to improve implementation centered on more education for doctors （82.1% ）, simplifying the guidelines （69.7 % ）, and more education for patients （53.1% ）. Conclusion： Chinese cardiologists need updated native clinical guidelines of ST-elevation myocardial infarction, as well as a Chinese guideline database. It is suggested that training for the implementation of the guidelines be strengtaened, both for doctors and patients.