北京市城区全科医生对调脂药物合理应用的掌握情况及其影响因素研究

Prevalence and Associated Factors of Rational Use of Lipid-regulating Agents in Urban General Practitioners in Beijing

背景随着我国大力推进分级诊疗制度,越来越多的居民选择到社区医院首诊,这就对全科医生的诊疗能力提出了很高的要求。全科医生对于血脂异常的认知程度及处理策略极大程度上影响我国居民血脂异常的控制水平。目的了解北京市城区全科医生对调脂药物合理应用的掌握情况及其影响因素。方法2019年3—5月采用分层抽样法从北京市城六区的社区卫生服务中心选取440例全科医生进行面对面问卷调查,问卷内容主要包括两部分:医生的基本信息及血脂异常合理用药遴选题目,其中药物遴选题目包括9个条目,满分为7分。结果回收有效问卷431份(98.0%)。9个血脂异常合理用药条目总平均得分为(3.72±1.49)分。不同性别、最高学历所学专业、参加血脂异常相关培训次数、每天接诊人数、接诊患者中血脂异常比例的全科医生血脂异常合理用药的药物遴选得分比较,差异有统计学意义(P<0.05)。多重线性回归分析结果显示,性别、血脂异常相关培训次数、接诊患者中血脂异常比例是全科医生血脂异常合理用药的药物遴选得分的影响因素(P<0.05)。结论北京城区全科医生血脂异常合理用药知识得分较低,应该有针对性地加强血脂异常相关知识培训,提高全科医生的血脂异常合理用药能力,从而对血脂异常患者进行更有效管理。

Background As China vigorously facilitates the implementation of tiered diagnosis and treatment system,there is an increasing number of residents who tend to make first visit with the community physician,which requires a relatively high diagnostic ability for general practitioners(GPs).And also,the management of dyslipidemia in Chinese residents could be heavily affected by GP's cognition and treatment strategies for dyslipidemia.Objective To examine the prevalence and associated factors of rational use of lipid-regulating agents in urban GPs in Beijing.Methods From March to May 2019,440 GPs were selected from community health centers in six urban districts of Beijing by stratified cluster random sampling for a faceto-face survey using a questionnaire developed by our research team involving demographics and rational use of lipid-regulating agents(assessed by a 9-item 7-point Likert scale).Results The survey obtained a response rate of 98.0%(431/440).The mean score for the 9 items about rational use of lipid-regulating agents scored by the respondents was(4.32±1.39).The score of the respondents regarding rational use of lipid-regulating agents differed significantly by sex,major of the highest education,number of receiving the training of dyslipidemia management,average number of daily visits,and the proportion of dyslipidemia cases encountered(P<0.05).Multiple linear regression analysis indicated that sex,number of receiving the training of dyslipidemia management,and proportion of dyslipidemia cases encountered were associated with rational use of lipid-regulating agents(P<0.05).Conclusion Overall,the urban GPs of Beijing obtained relatively low score of rational use of lipid-regulating agents.So it is suggested to strengthen the training of dyslipidemia management for these GPs to improve their level of rational use of lipid-regulating agents to better manage dyslipidemia patients.