基于Delphi法构建帕金森病社区规范管理方案

Development of a Standardized Community-based Management Scheme for Parkinson’s Disease Using the Delphi Technique

背景 帕金森病(PD)作为一种常见的神经系统变性疾病,病程长且严重影响患者生活质量。国际上已经开始建立专科医生与全科医生合作的PD患者全程管理模式,此管理模式可有效提高患者生活质量,并降低家庭、社会的负担。我国卫生管理体制与国外不同,目前尚缺乏适合我国的PD社区管理方案。目的 探索构建适合我国全科医生使用的PD社区规范管理方案。方法 检索2010-01-01至2020-12-31国内外发表的与PD诊疗管理相关的指南、规范和共识等文献,经全文筛选和提取,纳入PD社区规范管理方案的备选条目;进一步通过专家访谈,结合循证依据,拟定PD社区规范管理方案讨论条目;采用Delphi专家函询法构建适合我国全科医生使用的PD社区规范管理方案。结果 本研究邀请函询专家16名,两轮Delphi函询专家积极系数均为100.0%,两轮函询专家的权威程度系数分别为0.84和0.85,两轮问卷Kendall’s W系数分别为0.248(P<0.05)和0.255(P<0.05)。最终构建了包含“管理对象和内容”“上转建议”“接收建议”“疾病管理”4部分共77个条目的PD社区规范管理方案。结论 两轮函询专家的积极程度和权威程度较高,两轮函询后专家的意见趋于一致,专家意见协调性较好,结果可信。本研究所形成的PD社区规范管理方案可以指导全科医生参与PD临床随访和日常管理,以此来提高社区PD管理服务水平、减轻PD患者经济压力。

Background Parkinson’s disease(PD) is a common chronic neurodegenerative disease that seriously affects the quality of life of patients.Internationally,a whole-course specialist-general practitioner management mode of PD has been established,which can effectively improve the quality of life of patients and reduce PD burden on families and society.China has a health management system with its unique features,and lacks an applicable PD community management scheme.Objective To develop a standardized community-based management scheme for PD applicable to general practitioners(GPs) in China.Methods The full texts of guidelines,standards and consensuses related to PD diagnosis and management published from January 1,2010 to December 31,2020 were searched,and alternative items that could be included in the standardized community-based management scheme were screened and extracted,then relevant items were extracted to be used to develop a draft of standardized community-based management scheme for PD according to the experts interview and clinical evidence.After that,the draft was further revised under two rounds of email-based expert consultation using the Delphi technique.Results A total of 16 experts were invited to consult by e-mail for this study.The response rate was 100.0% for both two rounds.The authority coefficient and Kendall’s W were 0.84 and 0.248(P<0.05) for the first round of email-based consultation,and were 0.85 and 0.255(P<0.05) for the second round of email-based consultation.Finally,a standardized community-based management scheme was developed,which consists of four domains(managed subjects and contents,suggestions for upward referrals,suggestions for receiving referrals,and disease management) and 77 items.Conclusion The response rate and authority coefficient were high for both rounds of email-based expert consultation.After the consultation,the opinions of the experts tended to be consistent,indicating a high Kendall’s W,so the results are reliable.The scheme developed in this study may provide guidance for GPs in clinical follow-up and daily management of PD,so as to improve the level of PD management in the community and reduce the economic pressure of PD patients.