皋兰县乡镇卫生院医务人员临床决策依据调查

目的调查甘肃省皋兰县乡镇卫生院医务人员的临床决策依据,探讨其临床决策的科学性及合理性。方法自行设计乡镇卫生院医务人员临床决策依据调查问卷,对该县7所卫生院108位医务人员进行现场调查,问卷内容包括被调查者基本情况、临床决策依据的一般情况和被调查者的临床决策与当前最佳临床证据的对比情况三部分。结果共发放调查问卷108份,收回有效问卷89份。调查结果显示:79%的乡镇卫生院医务人员对患者作出诊断和治疗的主要依据为医学教科书;53%的医务人员在选择诊疗方案时最先考虑疗效;33%的医务人员在作临床决策时未能很好地考虑患者的意愿和价值观;52%的乡镇卫生院医务人员针对常见病与多发病制定的临床诊疗方案与BMJ出版的《临床证据》一书中推荐的最佳证据不符。结论当前乡镇卫生院医务人员进行临床决策时未能利用最佳临床证据和充分考虑患者的意愿及价值观,亟需在基层推广循证医学理念,传播最佳临床证据。

Clinical Decision-Making by Doctors in Township Hospitals in Gaolan:A Questionnaire Survey

Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan,Gansu province,and to discuss its scientificity and rationality.Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county.The investigation contained three parts as follows: basic information of respondents,general information of clinical decision-making evidence,and comparison between respondents’ decision-making situation and current best clinical evidence.Results Among the total 108 questionnaires distributed,89 valid were retrieved.The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks;53% took curative effect into consideration in the first place;33% failed to consider patients’ willingness properly when making clinical decisions;and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence.Conclusion While making clinical decisions,doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis,and fail to take patients’ value and willingness into consideration properly.It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.