关于中国临床医师对眼科临床指南认知程度的问卷调查分析

摘要

背景 眼科临床指南(PPP)是供广大眼科医师参考以规范医疗实践活动的循证文件,迄今为止在中国已经推广10余年,但PPP在中国眼科的推广和使用情况目前尚未见报道. 目的 从临床问题出发了解眼科医师对眼科临床指南的认知情况.方法 采用现场调查问卷研究方法,由经过培训的调查员于2014年9月17-21日在第十九次全国眼科学术大会暨第十七届亚非眼科大会会场无重复地发放问卷,就眼科医师对眼科PPP的认知情况进行自填式问卷调查.问卷由课题组参考以往发表的文章讨论后设计,包括被调查者个人基本情况及对PPP认知情况2大部分,对PPP认知情况又分为自我评价和PPP认知评分,其中自我评价量化为对PPP比较了解、了解、不太了解和很不了解的人数构成比,并根据有效答卷中的情况对PPP认知程度进行分级,0～4分为认知程度差,5～8分为认知程度中等,9～ 12分为认知程度好.被调查者采取匿名方式填写问卷,漏答任意1道临床问题的答卷视为无效答卷.结果 现场共发放问卷300份,回收问卷282份,其中有效问卷209份,有效率为74.1％.了解眼科PPP者97人,占46.4％,不了解者112人,占53.6％.眼科医师对眼科PPP的了解情况与其临床问题认知得分之间呈正相关(r=0.143,P＜0.05).不同教育程度间眼科医师对临床问题认知得分差异有统计学意义(F=12.26,P＜0.05),教育背景在硕士学历以下者临床问题认知得分明显低于博士学历者(均P＜0.05).眼科医师对各项临床问题的认知与相应的眼科PPP推荐的指导意见间吻合率最高为83％,最低为1％.结论 中国眼科医师对PPP的了解程度不够,因此影响了医师对临床问题的认知程度.眼科医师对各项临床问题的认知与PPP推荐的指导意见吻合率欠佳,提示眼科医师应提高依据PPP解决临床问题的意识.%Background Preferred practice pattern (PPP) is an evidence-based documents which can be used for reference to standardize medical practice by ophthalmologists.So far it has been promoted for more than 10 years in China.However,there is no report about the popularization and application of PPP in China.Objective This study was to investigate the cognitions of ophthalmologists to PPP from the view of clinical questions.Methods A questionnaire-based study was conducted.Questionnaires were dispensed during September 17 to 21,2014 to inquiry into the cognitions of ophthalmologists to PPP in the 19th Congress of Chinese Ophthalmological Society.A selfadministered questionnaire was designed and discussed according to the article published in the past by our research group.It included personal basic information and cognitions to PPP,and the latter consisted of self-assessment and cognition scoring.The constituent ratios of aware,quite aware,unaware and fully unaware ophthalmologists were counted.The cognitions were divided into low level (0-4 scores),moderate level (5-8 scores) and high level (9-12 scores) based on the effective answer sheets.The questionnaires were filled out anonymously and incomplete questionnaires were excluded.Results Among the 300 distributed questionnaires,282 were retrieved and 209 were valid,with the effective rate 74.1％.The ophthalmologists of awareness to PPP were 46.4％ (97/209),and 53.6％ (112/209) of respondents did not know PPP very well.A positive correlation was found between the awareness to PPP and the cognition scores to clinical issues (r,=0.143,P ＜ 0.05).The cognition scores to clinical issues were significantly different among different educational backgrounds (F =12.26,P ＜ 0.05),and cognition scores were significantly reduced in the ophthalmologists with lower master degree in comparison with the ophthalmologists with doctoral degree (all at P＜0.05).The coincide ratio between cognitions of ophthalmologists to different clinical issues and suggestions in PPP were evidently different in the ophthalmologists,with the highest coincide ratio 83％ and the lowest coincide ratio 1％.Conclusions The awareness to PPP is not adequate in Chinese eye doctors,which reduces the cognition level to clinical issues.There is a poor coincide ratio between cognitions of Chinese ophthalmologists to clinical issues and suggestions in PPP.This study emphasizes the need for effective awareness programs towards clinical issues based on PPP.