外阴阴道假丝酵母菌病过度医疗现况调查

A cross-sectional investigation on excess medical treatment of vulvovaginal candidiasis

目的:了解医疗机构外阴阴道假丝酵母菌病过度诊断和过度治疗的现状,为制定外阴阴道假丝酵母菌病标准化、规范化诊断治疗规范提供参考依据,以减少患者的就医成本及医疗资源的浪费。方法:通过对深圳地区综合医院、专科医院、计划生育服务中心和私营医院的93名妇产科医生、皮肤性病科医生、计划生育科医生和检验科医生进行匿名问卷调查,了解他们诊断和治疗外阴阴道假丝酵母菌病的实际操作方法,与临床诊疗操作规程进行对比。结果:①调查医生平均年龄为(38.6±9.3)岁,最小的22岁,最大的61岁;从事医疗工作平均年限为16.3年,文化程度以大专和本科为主,占62.4%,硕士及以上占23.7%,其他学历占13.9%。②39名实验室检验科医生中,29名出现过度诊断,占74.4%。③临床医生诊断过程中,35.2%的医生以实验室诊断作为判断标准,77.8%临床医生出现过度诊断。④77.8%的临床医生会给患者过度治疗用药。⑤在治疗外阴阴道假丝酵母菌病的过程中,对育龄妇女性伴侣的治疗不规范。⑥无症状外阴阴道假丝酵母菌病会影响计划生育手术的进行。结论:临床医生和实验室医生过度医疗情况比较严重,且影响计划生育手术的进行,因此,应加强对临床诊疗工作的规范化管理,减少医疗资源浪费。

Objective：To understand the status of over-diagnosis and over-treatment of vulvovaginal candidiasis in medical institutions,provide a basis for making standardizing and regulatory diagnosis and treatment criterions of vulvovaginal candidiasis,in order to reduce the cost and save medical sources.Methods：93 doctors who were working in the obstetrics and gynecology department,skin and venerology section,family planning department and clinical laboratory of the general hospitals,specialized hospitals,family planning services centers and private hospitals were surveyed by anonymous questionnaires,the actual diagnosis and treatment of vulvovaginal candidiasis were understood,then the results were compared with clinical operating instructions.Results：The average age of the investigated doctors was（38.6±9.3） years old,from 22 years to 61 years;the average medical work time was 16.3 years;educational levels： the proportions of college and university,master or higher,other educational levels were 62.4%,23.7% and 13.9%,respectively;among 39 laboratory doctors,29 doctors had over-diagnosis,accounting for 74.4%;among the clinical doctors,35.2% of them selected laboratory diagnosis as standard,77.8% of them had over-diagnosis;77.8% of the clinical doctors had over-treatment;during the course of treatment of vulvovaginal candidiasis,the treatment was not standard;asymptomatic vulvovaginal candidiasis affected the process of family planning operations.Conclusion：The status of excess medical treatment in clinical doctors and medical laboratory doctors are severe,which affect the process of family planning operations;thus,the standardized management of clinical work of clinical diagnosis and treatment should be enhanced to save medical sources.