三级医院临床医师循证医学认知及服务需求分析
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摘要
目的通过调查了解三级医院临床医师对循证医学的认知及服务需求情况,为循证医学的发展及其在临床实践中的进一步推广提供科学依据和参考。方法以河南省12家三级医院,898名临床医师为研究对象,采用统一自填式问卷调查其对循证医学的认知及服务需求情况。结果本研究共发放并回收问卷916份,其中有效问卷898份,有效回收率98.03%。被调查的研究对象男女性别比为0.96∶1,平均年龄36.4(25.0～59.0)岁。对循证医学重要性的总体认可度高达90.98%,对循证医学相关知识的需求率为93.43%。三级医院临床医师对循证医学相关知识需求度较高的依次是循证医学专业资源库(91.20%),文献检索的技巧(90.09%),如何发表高质量的循证医学论文(89.42%),循证医学证据的评价(86.41%)及循证医学的实施步骤(82.52%);期望获取循证医学相关知识的方式方面,总体需求率从高到低依次为微信公众号(92.09%),讲座培训(89.42%),学术会议(84.63%),同事交流(84.41%),课程研修(82.74%),专著期刊(80.85%)以及网站宣传(78.40%)。此外,不同年龄、不同工作年限、不同学历、不同科室间的临床医师对循证医学重要性的认识和需求差异有统计学意义。结论三级医院临床医师对循证医学重要性认识度较高,对循证医学相关知识的需求也较大,应根据临床医生的不同需求,有针对性及侧重点地制定措施、进行培训、促进实践。
Objective To understand the cognitive status and service demands of clinician for evidence-based medicine in first-class hospitals in Henan, and to provide scientific reference for the development of evidence-based medicine and its further application in clinical practice. Methods A unified self-administered questionnaire survey was conducted among 898 clinicians randomly selected from 12 first-class hospitals in Henan and data were analyzed using SPSS 23.0. Results A total of 916 questionnaires were distributed and 898 were valid questionnaires with the effective recovery rate of 98.03%.The male to female subject ratio was 0.96∶1, with the average age of 36.4(25.0-59.0) years.The overall rate of recognition for the importance of evidence-based medicine was 90.98%, and the rate of reporting a demand for knowledge related to evidence-based medicine was 93.43% with the highest demand of 91.20% in the resource of evidence-based medicine, 90.09% in literature search skills, 89.42% in the method for publishing high-quality evidence-based medical papers,86.41% in evaluation of evidence-based medical evidence and 82.52% in the procedure of evidence-based medicine implementation. In terms of the way of acquiring knowledge related to evidence-based medical science, the overall demand rate was the highest of 92.09% for WeChat public number, followed by lecture training(89.42%), academic conference(84.63%), colleagues exchange(84.41%), course training(82.74%), monographs(80.85%) and website propagation(78.40%).In addition, the cognitive ability for the importance of evidence-based medicine and demands for the knowledge varied significantly among clinicians with different ages,years of work,academic qualifications,and in different departments. Conclusions The clinicians in first-class hospitals have high awareness of the importance of evidence-based medicine,and high demands for evidence-based medicine related knowledge.Targeted programs and trainings should be provided to clinicians based on their specific demands.
Objective To understand the cognitive status and service demands of clinician for evidence-based medicine in first-class hospitals in Henan, and to provide scientific reference for the development of evidence-based medicine and its further application in clinical practice. Methods A unified self-administered questionnaire survey was conducted among 898 clinicians randomly selected from 12 first-class hospitals in Henan and data were analyzed using SPSS 23.0. Results A total of 916 questionnaires were distributed and 898 were valid questionnaires with the effective recovery rate of 98.03%.The male to female subject ratio was 0.96∶1, with the average age of 36.4(25.0-59.0) years.The overall rate of recognition for the importance of evidence-based medicine was 90.98%, and the rate of reporting a demand for knowledge related to evidence-based medicine was 93.43% with the highest demand of 91.20% in the resource of evidence-based medicine, 90.09% in literature search skills, 89.42% in the method for publishing high-quality evidence-based medical papers,86.41% in evaluation of evidence-based medical evidence and 82.52% in the procedure of evidence-based medicine implementation. In terms of the way of acquiring knowledge related to evidence-based medical science, the overall demand rate was the highest of 92.09% for WeChat public number, followed by lecture training(89.42%), academic conference(84.63%), colleagues exchange(84.41%), course training(82.74%), monographs(80.85%) and website propagation(78.40%).In addition, the cognitive ability for the importance of evidence-based medicine and demands for the knowledge varied significantly among clinicians with different ages,years of work,academic qualifications,and in different departments. Conclusions The clinicians in first-class hospitals have high awareness of the importance of evidence-based medicine,and high demands for evidence-based medicine related knowledge.Targeted programs and trainings should be provided to clinicians based on their specific demands.
引文
[1] 徐志伟,王雪梅,张晓菊,等.某高校医学院硕士研究生临床流行病学认知状况调查及教学成绩影响因素研究[J].现代预防医学,2018,45(12):2297-2300.
[2] 董杉,戴姣,陈一婷.广州市三级医院临床医生对循证医学及Meta分析的临床应用需求调查[J].临床医药文献电子杂志,2018,28(5):170-171.
[3] Saini V,Brownlee S,Elshaug AG,et al.Addressing overuseand underuse around the world [J].Lancet,2017,390 (10090):105-107.
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[5] 韩锦,郝广华,闫静,等.临床路径与循证医学相结合应用于心内科住院医师规范化培训[J].医学教育研究与实践,2018,26(2):355-357.
[6] 汪安江,谢勇,郑雪莲,等.消化医师循证医学实践情况及其相关因素调查[J].中国循证医学杂志,2012,12(9):1056-1062.
[7] 徐志伟,杨永光,张晓菊,等.住院患者对分级诊疗制度的认知状况调查及其影响因素研究[J].河南医学研究,2017,26(16):2887-2890.
[8] 薛萌.医学信息检索在循证医学中的应用[J].现代信息科技,2018,2(3):133-134.
[9] Berwick DM.Avoiding overuse-the next quality frontier [J].Lancet,2017,390 (10090):102-104.
[10] Saini V,Garcia-Armesto S,Klemperer D,et al.Drivers of poormedical care [J].Lancet,2017,390 (10090):178-190.
[11] Glasziou P,Straus S,Brownlee S,et al.Evidence for underuseof effectivemedical services around the world [J].Lancet,2017,390 (10090):169-177.
[12] Brownlee S,Chalkidou K,Doust J,et al.Evidence for overuseof medical services around the world [J].Lancet,2017,390(10090):156-168.
[13] 徐志伟,伍成奇,楚亦文,等.新生儿接种乙肝疫苗后无(弱)应答情况及其影响因素研究[J].现代预防医学,2016,43(21),4015-4018,4023.
[14] Bibbins-Domingo KUS.Preventive Services Task Force.Aspirin use for the primary prevention of cardiovascular diseaseand colorectal cancer:U.S.preventive services task force recommendationstatement [J].Ann Intern Med,2016,164 (12):836-845.
[15] Elshaug AG,RosenthalMB,Lavis JN,et al.Levers for addressingmedical underuse and overuse:achieving high-value health care[J].Lancet,2017,390 (10090):191-202.
[16] 王吉耀,唐金陵,陈世耀.再谈循证医学[J].中国循证儿科杂志,2017,12(3):161-163.
[17] 吴宛玲,王小钦.应用循证医学三大要素进行医患共同决策减少过度治疗[J].老年医学与保健,2018,24(2):105-107,117.
[18] Lane R.Vikas Saini:leading activist in the Right Care Alliance[J].Lancet,2017,390 (10090):117.
[19] 刘谦,秦明照,刘国樑.循证医学课程教学效果分析及对策探讨[J].医学教育管理,2017,3(2):97-100.
[20] 胡晶,张会娜,李博,等.临床流行病学在中医科研教学中的思考[J].继续医学教育,2018,32(2):76-77.
[21] 张玲,刘括,曹寒,等.临床流行病学教学方法改革与成效[J].基础医学教育,2019,21(2):121-124.
[2] 董杉,戴姣,陈一婷.广州市三级医院临床医生对循证医学及Meta分析的临床应用需求调查[J].临床医药文献电子杂志,2018,28(5):170-171.
[3] Saini V,Brownlee S,Elshaug AG,et al.Addressing overuseand underuse around the world [J].Lancet,2017,390 (10090):105-107.
[4] 刘雅莉,刘广芝,徐志伟,等.河南省循证医学的应用现状及发展对策研究[J].医药论坛杂志,2019,40(1):1-3,8.
[5] 韩锦,郝广华,闫静,等.临床路径与循证医学相结合应用于心内科住院医师规范化培训[J].医学教育研究与实践,2018,26(2):355-357.
[6] 汪安江,谢勇,郑雪莲,等.消化医师循证医学实践情况及其相关因素调查[J].中国循证医学杂志,2012,12(9):1056-1062.
[7] 徐志伟,杨永光,张晓菊,等.住院患者对分级诊疗制度的认知状况调查及其影响因素研究[J].河南医学研究,2017,26(16):2887-2890.
[8] 薛萌.医学信息检索在循证医学中的应用[J].现代信息科技,2018,2(3):133-134.
[9] Berwick DM.Avoiding overuse-the next quality frontier [J].Lancet,2017,390 (10090):102-104.
[10] Saini V,Garcia-Armesto S,Klemperer D,et al.Drivers of poormedical care [J].Lancet,2017,390 (10090):178-190.
[11] Glasziou P,Straus S,Brownlee S,et al.Evidence for underuseof effectivemedical services around the world [J].Lancet,2017,390 (10090):169-177.
[12] Brownlee S,Chalkidou K,Doust J,et al.Evidence for overuseof medical services around the world [J].Lancet,2017,390(10090):156-168.
[13] 徐志伟,伍成奇,楚亦文,等.新生儿接种乙肝疫苗后无(弱)应答情况及其影响因素研究[J].现代预防医学,2016,43(21),4015-4018,4023.
[14] Bibbins-Domingo KUS.Preventive Services Task Force.Aspirin use for the primary prevention of cardiovascular diseaseand colorectal cancer:U.S.preventive services task force recommendationstatement [J].Ann Intern Med,2016,164 (12):836-845.
[15] Elshaug AG,RosenthalMB,Lavis JN,et al.Levers for addressingmedical underuse and overuse:achieving high-value health care[J].Lancet,2017,390 (10090):191-202.
[16] 王吉耀,唐金陵,陈世耀.再谈循证医学[J].中国循证儿科杂志,2017,12(3):161-163.
[17] 吴宛玲,王小钦.应用循证医学三大要素进行医患共同决策减少过度治疗[J].老年医学与保健,2018,24(2):105-107,117.
[18] Lane R.Vikas Saini:leading activist in the Right Care Alliance[J].Lancet,2017,390 (10090):117.
[19] 刘谦,秦明照,刘国樑.循证医学课程教学效果分析及对策探讨[J].医学教育管理,2017,3(2):97-100.
[20] 胡晶,张会娜,李博,等.临床流行病学在中医科研教学中的思考[J].继续医学教育,2018,32(2):76-77.
[21] 张玲,刘括,曹寒,等.临床流行病学教学方法改革与成效[J].基础医学教育,2019,21(2):121-124.