基层医院细菌感染性疾病诊断和评价合理使用抗菌药物建议手册(呼吸系统部分)编制

Formulation of Recommendation Manual for Diagnosis and Evaluation of Rational Use of Antibacterial Agents for Bacterial Infectious Diseases in Primary Hospitals(Part of Respiratory System)

目的编制基层医院门诊呼吸系统常见细菌感染性疾病诊断和评价合理使用抗菌药物建议手册,为相关部门制定相关政策提供参考。方法采用德尔菲法,首先,进行文献研究和专家深度访谈,召开小组会议初步拟定专家咨询问卷;其次,邀请来自西南地区18名呼吸内科专家和17名临床药师对问卷进行两轮专家评价;最后,通过变异系数和协调系数(分散程度)、中位数和共识率(集中程度)对数据结果进行评价,用专家的积极系数和权威程度来判断研究结果的可靠性。结果在诊断部分,列出了20种呼吸系统疾病诊断的专家评价中具有典型症状、体征及辅助检查的指标;在用药部分,对基层门诊机构常见的12种呼吸系统细菌感染性疾病的7种抗菌药物的临床应用进行了合理性判断。专家积极性和权威程度较高,变异系数在0~1之间,协调系数在0.5左右波动,结果可信。结论根据专家对各指标的共识程度完成了《基层医院门诊常见细菌感染性疾病诊断和评价合理使用抗菌药物建议手册(呼吸系统部分)》的构建工作。

Objective To establish a recommendation manual for diagnosis and evaluation of common bacterial infectious diseases of respiratory system in outpatients of primary hospitals and rational use of antibacterial agents has been compiled,and to provide reference for relevant departments to formulate relevant policies.Methods Delphi method was used in this study.Firstly,literature research and expert in-depth interviews were conducted,and group meetings were held to develop the expert consultation questionnaire.Secondly,18 respiratory experts and 17 clinical pharmacists from Southwest China were invited to conduct two rounds of expert evaluation on the questionnaire.Finally,the results were evaluated by the coefficient of variation,the coefficient of coordination(the degree of dispersion),the median and the consensus rate(the degree of concentration),and the reliability of the results was judged by the positive coefficient and the degree of authority of experts.Results In the diagnosis section,the typical symptoms,signs,and auxiliary examination indexes in the expert evaluation for the diagnosis of 20 kinds of respiratory diseases are listed.In the part of drug use,the rationality of clinical drug use of seven kinds of antibacterial agents for 12 kinds of common respiratory bacterial infectious diseases in primary care outpatient institutions was judged.The enthusiasm and authority of experts are high.The coefficient of variation and variation are between 0 and 1,and the coordination coefficient fluctuates within the range of 0.5.The results are reliable.Conclusion According to the consensus of experts on each index,a recommendation manual(respiratory part)for diagnosis and evaluation of rational use of antibacterial agents for bacterial infectious diseases in primary hospitals were formed.