基层医务人员心房颤动相关知识掌握情况及影响因素分析

Analyze Mastery of Atrial Fibrillation Related Knowledge and Its Influencing Factors among Grassroots Medical Staffs

背景随着人口老龄化的加剧,我国心房颤动(简称房颤)的患病率逐年上升。基层医务人员作为社区居民健康的“守门人”,其具备较高的房颤知识水平对于实现房颤规范化管理尤为重要。目的了解上海市奉贤区基层医务人员对房颤相关知识的掌握情况,分析其影响因素,为后续开展相关培训工作提供理论依据。方法本研究为横断面调查研究。于2021年6—7月,采用系统抽样法,选取来自上海市奉贤区21家社区卫生服务中心的基层医务人员[包括全科医生、护士、药剂师、公共卫生医师及其他医务人员(影像技/医师、检验技师、中医师等)]1393例为研究对象,使用自行编制的电子问卷对其进行调查,调查内容主要涉及调查对象的一般资料及房颤相关知识(房颤基本知识、抗凝治疗知识、心律/心率控制知识)掌握情况。比较不同岗位基层医务人员房颤相关知识的掌握情况,采用单因素Logistic回归、有序多分类或二元Logistic回归分析基层医务人员房颤相关知识掌握情况的影响因素。结果共回收有效问卷1383份,问卷有效回收率为99.28%。1383例基层医务人员中,506例(36.59%)为全科医生;房颤基本知识、抗凝治疗知识和心律/心率控制知识得分不及格者分别占54.88%(759/1383)、97.69%(1351/1383)和69.63%(963/1383)。不同岗位基层医务人员房颤基本知识、抗凝治疗知识和心律/心率控制知识得分水平比较,差异均有统计学意义(P<0.05)。有序多分类或二元Logistic回归分析结果显示,工作岗位和职称为基层医务人员房颤基本知识得分水平的影响因素(P<0.05);年龄、工作岗位为基层医务人员抗凝治疗知识得分是否达到及格及以上水平的影响因素(P<0.05);工作岗位、是否接受过规范化培训和一年内是否阅读过房颤指南为基层医务人员心律/心率控制知识得分水平的影响因素(P<0.05)。结论基层医务人员房颤相关知识的掌握情况总体不理想,尤其是抗凝治疗知识缺乏。应特别加强对非全科医生、职称级别较低及未接受过规范化培训的基层医务人员的房颤相关知识培训。

Background With the aging of the population,the prevalence of atrial fibrillation is increasing year by year. As the "gatekeepers" of community residents’ health,grassroots medical staff with a high level of knowledge about atrial fibrillation is particularly important for standardized management of atrial fibrillation. Objective To analyze the mastery of atrial fibrillation-related knowledge among grassroots medical staff in Fengxian District,Shanghai and its influencing factors,thus,providing a theoretical basis for subsequent training work. Methods This study is a cross-sectional survey study. From June to July 2021,a systematic sampling method was used to select 1 393 grassroots medical staff as the research objects including general practitioners,nurses,pharmacists,public health physicians and other medical staff(imaging technology/physician,laboratory technician,traditional Chinese medicine doctor and so on)from 21 community health service centers in Fengxian District,Shanghai. This study used a self-developed electronic questionnaire to investigate them. The contents of the questionnaire included general information and knowledge related to atrial fibrillation(basic knowledge about atrial fibrillation,knowledge about anticoagulant therapy and knowledge about rhythm/heart rate control). This study compared the mastery of atrial fibrillation-related knowledge among grassroots medical staff in different positions,and used univariate Logistic regression,ordinal multiple classification or binary Logistic regression to analyze the influencing factors of grassroots medical staff’s mastery of atrial fibrillation-related knowledge. Results A total of 1 383 valid questionnaires were recovered,and the valid questionnaire recovery rate was 99.28%. Among 1 383 grassroots medical staff,506 cases(36.59%)were general practitioners. 54.88%(759/1 383),97.69%(1 351/1 383)and 69.63%(963/1 383)failed in the basic knowledge about atrial fibrillation,knowledge about anticoagulation and knowledge about heart rhythm/heart rate control,respectively. There were statistically significant differences in the scores of atrial fibrillation knowledge,anticoagulation knowledge and heart rhythm/heart rate control knowledge among grassroots medical staff in different positions(P<0.05). Ordinal multiple classification or binary Logistic regression analysis showed that the position as a general practitioner and professional title were the influencing factors of score in the basic knowledge related to atrial fibrillation among grassroots medical staff(P<0.05). Age and position as a general practitioner were the influencing factors of whether the score in knowledge related to anticoagulation therapy reaches the pass level or above among grassroots medical staff(P<0.05). The position as a general practitioner,received standardized training and reading the atrial fibrillation guideline within one year were the influencing factors of the score in knowledge related to heart rhythm/heart rate control among grassroots medical staff(P<0.05). Conclusion The mastery of knowledge about atrial fibrillation among grassroots medical staff is generally not ideal,especially the lack of knowledge about anticoagulation therapy.Atrial fibrillation related knowledge training should be especially strengthened for grassroots medical staff who are not general practitioners,have low professional titles,and have not received standardized training.