应用德尔菲法构建全科适宜技术目录
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摘要
目的应用德尔菲法构建全科适宜技术目录,为全科适宜技术推广和全科医生临床技能培训提供参考。方法根据浙江大学医学院附属邵逸夫医院和杭州市2家社区卫生服务中心全科门诊前20位疾病的诊断资料及国内外全科医学相关文献,拟定目录框架,邀请14名来自三甲医院和社区医院的全科医生进行2轮专家咨询,评价专家积极系数、专家权威程度和专家意见协调程度,确定最终的全科适宜技术目录。结果 14名专家中本科学历9人、硕士及以上5人;副主任或主任医师12人,主治医师2人;从事全科医疗工作平均年限17.21年。2轮咨询专家积极系数均为100.00%,专家权威程度平均为0.891。第一轮咨询后,6个Ⅰ级指标的重要性和可行性W分别为0.170和0.244,56个Ⅱ级指标的重要性和可行性W分别为0.236和0.250 (均P<0.05),其中6个Ⅱ级指标的重要性或可行性CV≥0.25,予以剔除。第二轮咨询后,6个Ⅰ级指标的重要性和可行性W分别为0.245和0.247 (均P<0.05);50个Ⅱ级指标的重要性和可行性W分别为0.355和0.370,CV均<0.25。最终构建了基本诊疗技能、急救技能、症状学诊疗技能、慢性病管理技能、常见病诊疗技能和常用操作技能6个Ⅰ级指标和50个Ⅱ级指标组成的全科适宜技术目录。结论本研究专家的积极程度和权威程度较高,专家意见协调性较好,结果可靠,制定的全科适宜技术目录可推广应用。
Objective To construct an appropriate technology catalogue for general practice based on Delphi method,and toprovide reference for promoting appropriate techniques and training general practitioners. Methods The catalogue was brieflyconstructed based on literature reviews and the data of the top twenty diseases diagnosed in out-patient department of Sir RunRun Shaw Hospital and two community health service centers in Hangzhou. Two-round Delphi consultation was conducted byfourteen general practitioners coming from upper first-class hospitals and community hospitals. The final catalogue wasestablished according to evaluation of the degree of involvement,authority coefficient and Kendall's W values of the fourteenspecialists. Results Of the fourteen specialists,nine had bachelor's degrees and five had master's degrees or above;twelvewere deputy chief physicians or chief physicians and two were physicians. They were engaged in general practice for 17.21 years in average. The positive coefficients of the two rounds of consultations were both 100.00%. The authority coefficient ofthe specialists was 0.891. After the first round of consultation, the W values for importance and feasibility of 6 first-classindicators were 0.170 and 0.244, and the ones of 56 second-class indicators were 0.236 and 0.250(all P <0.05). Six ofsecond-class indicators were excluded because their coefficent of variation(CV) for importance and feasibility were morethan 0.25. After the second round of consultation,the W values for importance and feasibility of 6 first-class indicators were0.245 and 0.247,and the ones of 50 second-class indicators were 0.355 and 0.370(all P<0.05). The CV for each indicatorwas less than 0.25. Finally,an instructional catalogue was defined,consisting of 6 first-class indicators(basic diagnosis andtreatment skills, first aid skills, symptomatic diagnosis and treatment skills, chronic disease management skills, commondisease diagnosis and treatment skills, and common manipulative skills) and 50 second-class indicators. Conclusion Thedegrees of involvement, authority and consistency of the specialists were relatively high. The catalogue of appropriatetechnology for general practitice had good reliability and feasibility,which was worthy of promotion and application.
Objective To construct an appropriate technology catalogue for general practice based on Delphi method,and toprovide reference for promoting appropriate techniques and training general practitioners. Methods The catalogue was brieflyconstructed based on literature reviews and the data of the top twenty diseases diagnosed in out-patient department of Sir RunRun Shaw Hospital and two community health service centers in Hangzhou. Two-round Delphi consultation was conducted byfourteen general practitioners coming from upper first-class hospitals and community hospitals. The final catalogue wasestablished according to evaluation of the degree of involvement,authority coefficient and Kendall's W values of the fourteenspecialists. Results Of the fourteen specialists,nine had bachelor's degrees and five had master's degrees or above;twelvewere deputy chief physicians or chief physicians and two were physicians. They were engaged in general practice for 17.21 years in average. The positive coefficients of the two rounds of consultations were both 100.00%. The authority coefficient ofthe specialists was 0.891. After the first round of consultation, the W values for importance and feasibility of 6 first-classindicators were 0.170 and 0.244, and the ones of 56 second-class indicators were 0.236 and 0.250(all P <0.05). Six ofsecond-class indicators were excluded because their coefficent of variation(CV) for importance and feasibility were morethan 0.25. After the second round of consultation,the W values for importance and feasibility of 6 first-class indicators were0.245 and 0.247,and the ones of 50 second-class indicators were 0.355 and 0.370(all P<0.05). The CV for each indicatorwas less than 0.25. Finally,an instructional catalogue was defined,consisting of 6 first-class indicators(basic diagnosis andtreatment skills, first aid skills, symptomatic diagnosis and treatment skills, chronic disease management skills, commondisease diagnosis and treatment skills, and common manipulative skills) and 50 second-class indicators. Conclusion Thedegrees of involvement, authority and consistency of the specialists were relatively high. The catalogue of appropriatetechnology for general practitice had good reliability and feasibility,which was worthy of promotion and application.
引文
[1]王岚,杜亚平.中英全科医疗服务模式的比较与探讨[J].全科医学临床与教育,2011,9(3):241-243,245.
[2]房鑫,郝艳华,吴群红,等.我国全科医生现状成因分析与对策探讨[J].中华全科医学,2016,14(7):1199-1201,1213.
[3]郭雪,刘琴,于晓羽,等.中国适宜卫生技术评估研究的系统评价[J].中国循证医学杂志,2012,12(12):1407-1415.
[4]王春枝,斯琴.德尔菲法中的数据统计处理方法及其应用研究[J].内蒙古财经学院学报(综合版),2011,9(4):92-96.
[5]张立威,黄婉霞,徐庆锋,等.基于德尔菲法的全科医生转岗培训效果评估指标体系构建研究[J].中国全科医学,2013,16(25):2271-2273.
[6]丁晋飞,谈立峰,汤在祥,等.德尔菲法及其在公共卫生领域的应用和展望[J].环境与职业医学,2012,29(11):727-730.
[7]薛敏,马莎,刘薇,等.基于德尔菲法的卫生监督效能评价指标体系权重研究---以上海卫生监督机构为例[J].中国卫生监督杂志,2014,21(3):212-218.
[8]付咏梅.社区访视护理现状分析及访视护理质量评价指标的构建研究[J].中国社区医师,2013,29(20):90-94.
[9]李和伟,李炜良,袁纲.德尔菲法在中国社区卫生服务领域内的应用[J].中国公共卫生管理,2015,31(1):15-17.
[10]韦余东,张人杰,张新卫,等.应用德尔菲法构建疾控机构应急能力评价指标体系[J].浙江预防医学,2016,28(1):32-36.
[11]赵玉遂,许燕,吴青青,等.应用德尔菲法构建网络健康信息质量评价指标体系[J].预防医学,2018,30(2):121-124.
[12]周仲华,黄文娟,陈仕银,等.三级综合医院全科医疗门诊患者就诊原因及诊断情况研究[J].中国全科医学,2012,15(23):2652-2655.
[13]王慧,江孙芳,汪志良,等.上海某社区卫生服务中心2010-2014年疾病谱分析[J].中国初级卫生保健,2016,30(2):32-34.
[14]王荣英,李峰,支晓,等.基于门诊就诊疾病谱分析的综合医院全科医疗科在分级诊疗中的定位与发展探讨[J].中国全科医学,2016,19(28):3417-3421.
[15]MURTAGH J.John Murtagh’s general practice[M].New South Wales:Mc Graw-Hill Australia,2011:2.
[16]艾尔巴比.社会研究方法[M].李银河,译.成都:四川人民出版社,1987.
[17]曾光.现代流行病学方法与应用[M].北京:北京医科大学、中国协和医科大学联合出版社,1994:258-259.
[18]王高玲,别如娥.基于Delphi法的居民健康素养评价指标体系的研究[J].中国卫生统计,2013,30(5):676-679.
[19]韩鹏,陈校云,张铁山,等.基于德尔菲法的医院门诊及住院医学人文关怀指标体系研究[J].中国现代医学杂志,2015,25(17):70-77.
[20]程琮,刘一志,王如德.Kendall协调系数W检验及其SPSS实现[J].泰山医学院学报,2010,31(7):487-490.
[21]黄敬亨.健康教育学[M].上海:上海医科大学出版社,1997:212.
[22]赵学荣,张婕,陈艳.运用德尔菲法和层次分析法建立新疆高职乡村医师专业学生职业认同指标体系[J].新疆医科大学学报,2013,36(3):406.
[23]卢崇蓉,戴红蕾,朱文华,等.基于提高岗位胜任力的全科适宜技术培训模式的探讨[J].全科医学临床与教育,2016,14(3):241-242.
[24]王少娜,董瑞,谢晖,等.德尔菲法及其构建指标体系的应用进展[J].蚌埠医学院学报,2016,41(5):695-698.
[2]房鑫,郝艳华,吴群红,等.我国全科医生现状成因分析与对策探讨[J].中华全科医学,2016,14(7):1199-1201,1213.
[3]郭雪,刘琴,于晓羽,等.中国适宜卫生技术评估研究的系统评价[J].中国循证医学杂志,2012,12(12):1407-1415.
[4]王春枝,斯琴.德尔菲法中的数据统计处理方法及其应用研究[J].内蒙古财经学院学报(综合版),2011,9(4):92-96.
[5]张立威,黄婉霞,徐庆锋,等.基于德尔菲法的全科医生转岗培训效果评估指标体系构建研究[J].中国全科医学,2013,16(25):2271-2273.
[6]丁晋飞,谈立峰,汤在祥,等.德尔菲法及其在公共卫生领域的应用和展望[J].环境与职业医学,2012,29(11):727-730.
[7]薛敏,马莎,刘薇,等.基于德尔菲法的卫生监督效能评价指标体系权重研究---以上海卫生监督机构为例[J].中国卫生监督杂志,2014,21(3):212-218.
[8]付咏梅.社区访视护理现状分析及访视护理质量评价指标的构建研究[J].中国社区医师,2013,29(20):90-94.
[9]李和伟,李炜良,袁纲.德尔菲法在中国社区卫生服务领域内的应用[J].中国公共卫生管理,2015,31(1):15-17.
[10]韦余东,张人杰,张新卫,等.应用德尔菲法构建疾控机构应急能力评价指标体系[J].浙江预防医学,2016,28(1):32-36.
[11]赵玉遂,许燕,吴青青,等.应用德尔菲法构建网络健康信息质量评价指标体系[J].预防医学,2018,30(2):121-124.
[12]周仲华,黄文娟,陈仕银,等.三级综合医院全科医疗门诊患者就诊原因及诊断情况研究[J].中国全科医学,2012,15(23):2652-2655.
[13]王慧,江孙芳,汪志良,等.上海某社区卫生服务中心2010-2014年疾病谱分析[J].中国初级卫生保健,2016,30(2):32-34.
[14]王荣英,李峰,支晓,等.基于门诊就诊疾病谱分析的综合医院全科医疗科在分级诊疗中的定位与发展探讨[J].中国全科医学,2016,19(28):3417-3421.
[15]MURTAGH J.John Murtagh’s general practice[M].New South Wales:Mc Graw-Hill Australia,2011:2.
[16]艾尔巴比.社会研究方法[M].李银河,译.成都:四川人民出版社,1987.
[17]曾光.现代流行病学方法与应用[M].北京:北京医科大学、中国协和医科大学联合出版社,1994:258-259.
[18]王高玲,别如娥.基于Delphi法的居民健康素养评价指标体系的研究[J].中国卫生统计,2013,30(5):676-679.
[19]韩鹏,陈校云,张铁山,等.基于德尔菲法的医院门诊及住院医学人文关怀指标体系研究[J].中国现代医学杂志,2015,25(17):70-77.
[20]程琮,刘一志,王如德.Kendall协调系数W检验及其SPSS实现[J].泰山医学院学报,2010,31(7):487-490.
[21]黄敬亨.健康教育学[M].上海:上海医科大学出版社,1997:212.
[22]赵学荣,张婕,陈艳.运用德尔菲法和层次分析法建立新疆高职乡村医师专业学生职业认同指标体系[J].新疆医科大学学报,2013,36(3):406.
[23]卢崇蓉,戴红蕾,朱文华,等.基于提高岗位胜任力的全科适宜技术培训模式的探讨[J].全科医学临床与教育,2016,14(3):241-242.
[24]王少娜,董瑞,谢晖,等.德尔菲法及其构建指标体系的应用进展[J].蚌埠医学院学报,2016,41(5):695-698.