基于德尔菲法构建药师视角下慢性阻塞性肺疾病患者分级管理标准

Establishment of hierarchical management standard in patients with chronic obstructive pulmonary disease from the perspective of pharmacists based on Delphi method

目的构建药师视角下的慢性阻塞性肺疾病(COPD)患者分级管理标准。方法以金字塔分层分级管理模型为框架,通过文献研究,初步编制COPD患者分级管理标准的指标,设计函询问卷,并采用德尔菲法对18名专家进行两轮函询,确定分级管理标准的内容。结果2轮专家函询的问卷回收率均为100%,专家的权威系数均为0.903,各指标的肯德尔和谐系数为0.279、0.189,最终构建的COPD患者分级管理标准包括25个分层指标和17个药学分级管理指标。其中高危层、中危层、平稳层分别有9、8、8个指标,同时考虑到了疾病、用药和自我管理水平3个方面,对应的一级、二级、三级药学管理分别有6、6、5个指标,包括吸入技术指导、用药依从性指导、治疗监测和随访等维度。结论基于德尔菲法构建的COPD患者分级管理标准具有较好的科学性和可靠性,能为我国药师进行COPD患者的分级管理提供参考依据。

OBJECTIVE To develop a standard of hierarchical management for patients with chronic obstructive pulmonary disease(COPD)from the perspective of pharmacists.METHODS The triangle hierarchical management model was used as the framework.Through literature research,the indicators of the hierarchical management standard for COPD patients were preliminarily compiled.A questionnaire was designed and administered to 18 experts,and Delphi method was conducted in two rounds to determine the contents of the standard.RESULTS The response rates for both rounds of expert consultation were 100%,with both authority coefficients of experts of 0.903 and Kendall coordination coefficiens of 0.279 and 0.189 for each indicator.The final established standard of hierarchical management for COPD patients included 25 stratified indicators and 17 pharmaceutical hierarchical management indicators.There were 9,8 and 8 indicators in the high-risk,medium-risk,and stable layers,respectively,considering three aspects:disease,medication,and self-management level.The corresponding first-level,secondlevel,and third-level pharmaceutical management included 6,6 and 5 indicators,respectively,including inhalation technical guidance,medication adherence guidance,treatment monitoring,and follow-up,etc.CONCLUSIONS The standard of hierarchical management for COPD patients established by Delphi method is scientific and reliable,which can provide a reference for pharmacists to carry out hierarchical management of COPD patients in China.