基于全科医生的年龄相关性听力损失管理指标体系构建研究

Development of the General Practitioner Management of Age-related Hearing Loss System

背景随着我国人口老龄化程度的加深,年龄相关性听力损失发病率逐步增高,未经治疗的听力损失和诸多不良健康事件的发生密切相关。由于症状进展缓慢,老年听力损失不易被发现,其危害常被低估和忽视。基层全科医生可在听力损失患者的早期筛查、及时转诊、健康教育管理等方面发挥重要作用。目的构建基于全科医生的年龄相关性听力损失管理指标体系,推动基层听力损失二级预防和管理。方法于2021年4—6月,通过文献回顾、半结构式访谈,初步确立基于全科医生的年龄相关性听力损失管理指标体系。采用目的抽样法,于2021年8—11月邀请15例专家(来自耳鼻喉专科、全科医学、行政管理、公共卫生管理领域)作为函询对象,对其进行两轮函询,通过计算专家积极系数、专家权威系数、专家协调系数,并采用层次分析法评价各级指标权重、检验各级指标逻辑一致性,最终确定指标体系。结果初步构建的基于全科医生的年龄相关性听力损失管理指标体系由6个一级指标、15个二级指标组成。两轮专家函询问卷的有效回收率均为100.0%,专家权威系数分别为0.877、0.920,Kendall's W系数分别为0.428(χ^(2)=89.821,P<0.001)、0.307(χ^(2)=87.387,P<0.001)。最终确立的指标体系由6个一级指标(年龄相关性听力损失理论知识、年龄相关性听力损失筛查技能、年龄相关性听力损失转诊能力、耳科常见疾病的诊治能力、年龄相关性听力损失不良事件管理能力、医患沟通能力)和20个二级指标构成。所有指标的重要性赋值均数均>8.0分,变异系数均<0.250,满分比均>30.0%。6个一级指标的权重分别为0.082、0.082、0.082、0.077、0.077、0.077,各层级指标的一致性比率分别为0.0635、0.0432。结论参与函询的专家积极性、权威程度较高,意见较为集中;专家函询结果具备一定的科学性、可信度和可靠度。构建的指标体系可为基层全科医生年龄相关性听力损失二级预防和管理工作提供指导与参考。

Background The prevalence of age-related hearing loss is increasing gradually as population aging advances in China.Untreated hearing loss is strongly associated with many adverse health events.Age-related hearing loss is difficult to be detected due to slow progression of symptoms,and its harmfulness is often underestimated or neglected.General practitioners(GPs)in primary care could play a vital role in early screening,timely referral and health education management regarding age-related hearing loss.Objective To formulate an GP management of age-related hearing loss system,promoting secondary prevention and management of this illness in primary health care.Methods By use of literature review and semi-structured reviews,we developed the first draft of General Practitioner Management of Age-related Hearing Loss System from April to June 2021.For reviewing the draft,we conducted a two-round e-mail-based consultation with a purposive sample of 15 experts(engaging in the field of otolaryngology,general practice,administrative management or public health management)from August to November 2021.Then we calculated the response coefficient,authority coefficient and Kendall's W for the two consultations,assessed the weights of indicators using analytic hierarchy process,checked the logical consistency of indicators,and determined the final draftof age-related hearing loss management system.Results The first draft of General Practitioner Management of Age-related Hearing Loss System consisted of 6 primary indicators and 15 secondary indicators.The response coefficient was 100.0%for both consultations.The expert authority coefficient was 0.877 for the first round of consultation,and 0.920 for the second round.Kendall's W coefficients were 0.428(χ^(2)=89.821,P<0.001),and 0.307(χ^(2)=87.387,P<0.001),respectively for the first and second rounds of consultations.The final system consists of 6 primary indicators(theoretical knowledge of age-related hearing loss,screening skills for age-related hearing loss,referral ability of age-related hearing loss,ability to diagnose and treat ear diseases,ability to manage adverse events of age-related hearing loss,doctor-patient communication ability),and 20 secondary indicators.The mean value of importance for all indicators was above 8.000,the coefficient of variation of all indicators was above 0.250,and the full score ratio of all indicators was above 30.0%.The weights of the above-mentioned six primary indicatorswere 0.082,0.082,0.082,0.077,0.077,and 0.077,respectively.The consistency ratio of primary and secondary indicators was 0.0635,0.0432,respectively(<0.1000).Conclusion The response and authority coefficients,and Kendall's W coefficients of the consultations were high,suggesting that the consultation results were scientific,credible and reliable.This system can be used as a guidance system for secondary prevention and management of this illness by GPs in primary care.