中国眼科医师对循证医学认知及临床实践的调查及分析
중국안과의사대순증의학인지급림상실천적조사급분석
A survey of Chinese ophthalmologists' cognition and practice of evidence-based medicine
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2014年 10期 921-926 ,共6页

    孙芸芸%李仕明%康梦田%王宁利%詹思延

    손예예%리사명%강몽전%왕저리%첨사연

    循证医学%眼科医师%认知%实践%态度%横断面研究%问卷 循證醫學%眼科醫師%認知%實踐%態度%橫斷麵研究%問捲
    순증의학%안과의사%인지%실천%태도%횡단면연구%문권
    Evidence-based medicine%Ophthalmologist%Cognition%Practice%Attitude%Cross-sectional study%Questionnaire
    背景 目前国际上临床医师应用循证医学(EBM)进行医疗决策已达成共识,但中国眼科医师对EBM的认知仍处于了解阶段,调查中国眼科医师对EBM的认知情况及其态度有助于采取合理的方法进行EBM应用指导. 目的 了解中国眼科医师对EBM的认知和临床实践情况及面临的主要困难,为临床更好地指导EBM实践提供参考. 方法 采用横断面研究设计和调查问卷的方法,对参加第十八次全国眼科学术大会的全国各地233名眼科医师进行调查,问卷中包括受访者的一般资料、对EBM知识认知的方法和渠道、对EBM临床应用的态度、EBM的临床实践情况及其应用过程中的困难;对受访者的受教育程度及职称、所在医疗机构的等级、城市及医院性质进行分层,对不同知识层次的眼科医师间各种指标的差异进行比较和分析.结果 共收回调查问卷233份,应答率为100％,其中有效问卷214份,有效率为91.8％.受访者中50.5％(104/206)的眼科医师在本科学习阶段开始了解EBM,49.1％ (102/208)的眼科医师于近8年开始了解EBM.47.7％(101/211)的受访者认为临床实践应该以EBM为主,7.5％(16/211)的受访者表示不关心EBM,仅3.8％ (8/211)的受访者认为EBM对指导临床实践不太重要或很不重要.受访者中对EBM、系统评价和Meta分析、Cochrane图书馆及协作网、美国临床实践指南(PPPs)了解或比较了解者分别仅占69.1％ (148/214)、35.0％ (75/213)、21.5％ (46/213)和57.4％ (121/211).受访者中学历越高者,对上述4项的认知程度越高,不同受教育程度间整体比较差异均有统计学意义(P=0.000、0.000、0.001、0.000).在临床实践中,11.7％(25/211)的受访者会经常考虑应用EBM,学历越高,其在临床实践中考虑应用EBM的频率也越高,而在临床诊疗中碰到难题时,仅有17.8％(89/495,频次)的受访者会考虑查阅EBM研究结果,不同受教育程度者间应用EBM的频率差异有统计学意义(x2=13.406,P=0.037).影响EBM实践的前三位因素是工作忙,时间精力有限;难以正确合理评价EBM证据;以及缺乏循证治病有效或有参考价值的病例.受访者所使用EBM证据类型中最多的为医学数据库,占36.7％,使用中文、英文数据库最多的分别为CNKI和PubMed,分别占33.5％和38.4％,从未检索过中文、英文数据库者分别占7.3％和17.2％. 结论 中国眼科医师对EBM的认知情况及其在临床实践中应用EBM的频率仍然不高.应从医学生培养的早期加强EBM的培训,并采取相应措施鼓励眼科医师在临床实践中合理应用EBM.
    배경 목전국제상림상의사응용순증의학(EBM)진행의료결책이체성공식,단중국안과의사대EBM적인지잉처우료해계단,조사중국안과의사대EBM적인지정황급기태도유조우채취합리적방법진행EBM응용지도. 목적 료해중국안과의사대EBM적인지화림상실천정황급면림적주요곤난,위림상경호지지도EBM실천제공삼고. 방법 채용횡단면연구설계화조사문권적방법,대삼가제십팔차전국안과학술대회적전국각지233명안과의사진행조사,문권중포괄수방자적일반자료、대EBM지식인지적방법화거도、대EBM림상응용적태도、EBM적림상실천정황급기응용과정중적곤난;대수방자적수교육정도급직칭、소재의료궤구적등급、성시급의원성질진행분층,대불동지식층차적안과의사간각충지표적차이진행비교화분석.결과 공수회조사문권233빈,응답솔위100％,기중유효문권214빈,유효솔위91.8％.수방자중50.5％(104/206)적안과의사재본과학습계단개시료해EBM,49.1％ (102/208)적안과의사우근8년개시료해EBM.47.7％(101/211)적수방자인위림상실천응해이EBM위주,7.5％(16/211)적수방자표시불관심EBM,부3.8％ (8/211)적수방자인위EBM대지도림상실천불태중요혹흔불중요.수방자중대EBM、계통평개화Meta분석、Cochrane도서관급협작망、미국림상실천지남(PPPs)료해혹비교료해자분별부점69.1％ (148/214)、35.0％ (75/213)、21.5％ (46/213)화57.4％ (121/211).수방자중학력월고자,대상술4항적인지정도월고,불동수교육정도간정체비교차이균유통계학의의(P=0.000、0.000、0.001、0.000).재림상실천중,11.7％(25/211)적수방자회경상고필응용EBM,학력월고,기재림상실천중고필응용EBM적빈솔야월고,이재림상진료중팽도난제시,부유17.8％(89/495,빈차)적수방자회고필사열EBM연구결과,불동수교육정도자간응용EBM적빈솔차이유통계학의의(x2=13.406,P=0.037).영향EBM실천적전삼위인소시공작망,시간정력유한;난이정학합리평개EBM증거;이급결핍순증치병유효혹유삼고개치적병례.수방자소사용EBM증거류형중최다적위의학수거고,점36.7％,사용중문、영문수거고최다적분별위CNKI화PubMed,분별점33.5％화38.4％,종미검색과중문、영문수거고자분별점7.3％화17.2％. 결론 중국안과의사대EBM적인지정황급기재림상실천중응용EBM적빈솔잉연불고.응종의학생배양적조기가강EBM적배훈,병채취상응조시고려안과의사재림상실천중합리응용EBM.
    Background Evidence-based medicine (EBM) has been widely applied to solve clinical issues internationally,however,the awareness of oculists in China still is dissatisfied,and the relevant issue survey can offer the training guidance.Objective This study was to survey the status of the cognition and practice of EBM in ophthalmologists in China and analyze the problems in their EBM practice.Methods Two hundred and thirty-three ophthalmologists were enrolled in the 18th Congress of Chinese Ophthalmological Society in August,2013.A survey about EBM was performed by self-made questionnaire,including general data from the surveyors,the way and channel of understanding EBM,the attitude toward EBM,clinical practice of EBM and influencing factors.The educational background,professional qualifications,ranked distribution of hospitals which surveyors came from,size of the citys and attribute of hospitals were stratified and analyzed.SPSS 17.0 software was used for statistical analysis.Results A total of 233 questionnaires were distributed,and 233 were regained with the response rate 100％,and 214 valid questionnaires were included,with the effective rate 91.8％.50.5％ of the respondents (104/206) knew EBM in university.The proportion of those believe EBM initially as medical students was 41.8％,and 49.1％ (102/208) were aware of EBM in recent 8 years.And 47.7％ (101/211) believed that EBM should be given priority in clinic,and 7.5％ (16/211) were indifferent to EBM.Only 3.8％ (8/211) surveyors thought EBM to be little important.The proportion of the respondents choosing ‘ know’ or ‘ moderately-know’ were 69.1％ (148/214),35.0％ (75/ 213),21.5％ (46/213) and 57.4％ (121/211) respectively in EBM,Meta analysis,Cochrane as well as Preferred Practice Patterns (PPPs) with a higher receiving degree in well-educated individuals (P =0.000,0.000,0.001,0.000).EBM was well practiced in 11.7％ (25/211) oculists,with a higher using frequency in senior ophthalmologists,and 17.8％ (89/495,frequency) oculists consulted the EBM literature to resolve problems in clinic,with a significant difference in the using frequency of EBM among the different educational background subjects (x2=13.406,P=0.037).The top three barriers which affected the application of EBM in clinical practices were lack of time and the limited energy,feeling it difficult to evaluate the evidence correctly as well as the absence of cases proving the efficacy to treat based EBM.The type of EBM evidence mostly used by respondents was medical database (36.7％),and CNKI (33.5％) and PubMed (38.4％) were the mostly used Chinese and English database,respectively.Respondents who have never searched the Chinese or English database occupied up to 7.3％ and 17.2％,respectively.Conclusions The cognition degree and applying frequency are still lower in ophthalmologists in China.The training of EBM should be strengthened in medical students.The guidance measurement should be taken to encourage eye doctors to apply EBM.
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