《中医内科临床诊疗指南——头痛》制定中患者偏好与价值观的调查研究

Investigation on Patients’Preferences and Values in Formulation of Guidelines for Clinical Diagnosis and Treatment of Internal Medicine of Traditional Chinese Medicine:Headache

目的:研究原发性头痛患者偏好与价值观,为形成推荐意见强度分级共识时提供参考。方法:采用横断面网络调查,通过半开放式电子问卷形式,使用视觉模拟评分(VAS)测量影响患者选择治疗措施的考虑因素重要性、总体治疗措施方向、头痛辨证汤剂治疗、原发性头痛的中成药及非药物治疗措施等方面的偏好与价值观。结果:调查共纳入研究对象217人。影响患者选择治疗措施的考虑因素重要性评分、总体治疗措施方向的偏好评分、偏头痛及紧张型头痛治疗措施的偏好评分差异具有统计学意义(P<0.01)。患者在选择治疗措施时最关注疗效,总体偏好于选择非药物疗法。在偏头痛治疗中,患者对针刺治疗偏好程度最高;在治疗紧张型头痛时,患者对推拿治疗的偏好程度最高;在治疗丛集性头痛时,患者对不同干预措施没有表现出明显偏好。结论:总体上,不良反应少的非药物疗法,如针灸、推拿等在原发性头痛治疗中更受患者欢迎,临床实践指南的制定应该考虑头痛患者的这一偏好与价值观结果。

Objective:To study the preferences and values of patients with primary headache and provide a reference for forming a consensus on the strength of recommendation opinions.Methods:A cross-secti-onal network survey,a semi-open electronic questio-nnaire and visual analog scale(VAS)were used to measure the preferences and values affecting patients’choices of treatment measures,the importance of considerations,the direction of overall trea-tment measures,treating headache with syndrome differentiation and decoction,and Chinese patent medicine or non-pharmacological treatment in primary headache.Results:The survey included 217 subjects.Differences in the importance scores of consideration factors that influence patients'choice of treatment measures,preference scores for overall treatment measures,and preference scores for migraine and tension headache treatment measures were statistically significant(P<0.01).Patients are most concerned about efficacy when choosing treatments,and generally prefer non-pharmacological therapies.In the treatment of migraine,patients had the highest preference for acupuncture;when treating tension headache,patients had the highest preference for massage therapy;when treating cluster headaches,patients did not show obvious preference for different interventions.Conclusions:In general,non-pharmacological therapies with relatively few adverse reactions,such as acupuncture and massage,are more popular with patients in the treatment of primary headache.The development of clinical practice guidelines should take into account the preferences and values of patients with headache.