CAJ | 학술논문

目的：了解社区医生抗生素的临床用药行为及影响因素，为针对性开展临床合理使用抗生素的健康教育干预提供依据。方法于2013年3-7月，对甘肃省6个县区各自选取的2所规模相当的社区卫生服务中心/乡镇卫生院的临床医生进行问卷调查。问卷收集了社区医生临床应用抗生素的认知、体验及用药行为相关的信息。运用 SAS 9.1统计软件进行数据分析。结果共发放调查问卷240份，回收有效问卷239份，有效回收率为99.6%。社区医生对应该遵循的抗生素临床合理用药相关行为的一直坚持实践率为36.0%~65.3%，对抗生素相关知识的正确回答率为67.4%~97.1%，主观体验到的临床合理应用抗生素的障碍因素主要有“自身的抗生素相关知识还有待学习提高”（57.3%，137/239）、“缺乏诊断支持，担心初诊不用抗生素会产生不良后果”（54.0%，129/239）、“患者或家属坚决要求的态度，为防止医患纠纷只好满足”（49.4%，118/239）。认知得分与用药行为呈正相关（rs =0.41，P <0.0001），主观体验得分与用药行为无相关关系（rs =0.01，P =0.913）。结论社区医生对抗生素的合理应用仅部分得以贯彻和实践，认知仍是影响其抗生素用药行为的重要因素，尚不能确定临床用药的主观感受对其用药行为的影响。因此，须将加强针对性的知识培训、关注临床医生的体验及开展用药行为的动态督导有机结合，构建系统的干预策略，以切实改善社区医生临床抗生素用药行为。
목적：료해사구의생항생소적림상용약행위급영향인소，위침대성개전림상합리사용항생소적건강교육간예제공의거。방법우2013년3-7월，대감숙성6개현구각자선취적2소규모상당적사구위생복무중심/향진위생원적림상의생진행문권조사。문권수집료사구의생림상응용항생소적인지、체험급용약행위상관적신식。운용 SAS 9.1통계연건진행수거분석。결과공발방조사문권240빈，회수유효문권239빈，유효회수솔위99.6%。사구의생대응해준순적항생소림상합리용약상관행위적일직견지실천솔위36.0%~65.3%，대항생소상관지식적정학회답솔위67.4%~97.1%，주관체험도적림상합리응용항생소적장애인소주요유“자신적항생소상관지식환유대학습제고”（57.3%，137/239）、“결핍진단지지，담심초진불용항생소회산생불량후과”（54.0%，129/239）、“환자혹가속견결요구적태도，위방지의환규분지호만족”（49.4%，118/239）。인지득분여용약행위정정상관（rs =0.41，P <0.0001），주관체험득분여용약행위무상관관계（rs =0.01，P =0.913）。결론사구의생대항생소적합리응용부부분득이관철화실천，인지잉시영향기항생소용약행위적중요인소，상불능학정림상용약적주관감수대기용약행위적영향。인차，수장가강침대성적지식배훈、관주림상의생적체험급개전용약행위적동태독도유궤결합，구건계통적간예책략，이절실개선사구의생림상항생소용약행위。
Objective To understand community doctors' clinical usage of antibiotics and the influencing factors and to provide reference for health education about reasonable use of antibiotics. Methods Clinical doctors in community health service centers/ township hospitals selected from 6 counties and districts of Gansu province(2 centers/ hospitals from each)in 2013 from March to July were investigated by questionnaire including doctors' knowledge of clinical usage of antibiotics,experiences and be-haviors. SAS9. 1 software was used for data analysis. Results 240 questionnaires were distributed. 239 were returned and the rate was 99. 6%. The level of abiding strictly by the rational behaviors related antibiotics use was 36. 0% - 65. 3%. The correct rate of knowledge about antibiotics was 67. 4% - 97. 1%. The main obstacles of rational use of antibiotics which was from clinical doctors' subjective experience were " more knowledge about antibiotics should be learnt"(57. 3% ,137 / 239 )," worrying about nega-tive consequences of no antibiotics in first visit because of no enough diagnostic supports" (54. 0% ,129 / 239)," to prevent from medical dispute because the patient or family insisted on using antibiotics"(49. 4% ,118 / 239). Awareness and drug - u-sing behavior were positively correlated(rs = 0. 41,P < 0. 000 1),subjective experiences had no linear correlation with drug use behavior(rs = 0. 01,P = 0. 913). Conclusion Reasonable use of antibiotics is only partly carried out and practiced among community doctors,and knowledge is still the important influencing factor for antibiotics use behaviors. It is not certain about the effect of subjective feeling on the clinical drug uses. Therefore,in order to practically improve antibiotics use behavior in clinic a-mong community doctors,systematic intervention strategy should be built based on specific knowledge training,organic combina-tion of attention to the experiences of clinic doctors with dynamic supervision of drug use behavior.