基于德尔菲法的痴呆社区管理工作内容构建研究

背景　随着人口老龄化的加剧，痴呆成为世界范围内的一个主要公共卫生问题，各国逐渐重视基层医疗的作用，强调了全科医生在痴呆早期识别及后续管理中的重要性，国际上一些国家建立了痴呆社区管理指南或者共识，我国目前仍没有痴呆社区管理相关指南或共识供全科医生参考。目的　探索构建社区卫生服务机构痴呆患者管理的工作内容，为今后痴呆社区管理提供依据。方法　2018年8月-2019年1月，首先成立课题核心小组，初步拟定痴呆社区管理工作内容指标，然后选择神经内科、精神科、老年科、综合科、社区全科医生及社区护士共28名专家，采用德尔菲法经过两轮专家咨询，应用权威程度、协调系数及积极系数进行评价，最终建立痴呆社区管理工作内容指标体系。结果　两轮咨询的专家积极系数均为100%，一级指标专家权威程度均值为0.729。两轮评价指标重要性的专家协调系数分别为0.130和0.179（P<0.01），可行性的专家协调系数分别为0.195和0.207（P<0.01）。建立痴呆社区管理工作内容的指标体系包括2项一级指标、7 项二级指标、20项三级指标。2项一级指标分别为：痴呆的识别与筛查、痴呆确诊后的随访管理；7项二级指标分别为进行认知表现筛查、采用认知筛查量表评定、筛查过程中转诊、随访频次、临床随访内容、量表评定、随访过程中的转诊。结论　专家的积极程度和权威程度较高，两轮咨询后专家的意见趋于一致，专家意见协调性较好，结果可信，采用德尔菲法构建的痴呆社区管理内容可以为今后痴呆社区管理提供 参考。

The Content Construction of Dementia Management in Community Based on Delphi Method

Background　With the aging of the population being intensifying，dementia has become a major public health problem worldwide.Many countries have gradually attached importance to the role of primary care and emphasized the importance of general practitioners in the early identification of dementia and its follow-up management.Some countries in the world have established guidelines and consensus on the management of dementia in community，while there are still no guidelines or consensus on community dementia management for general practitioners in China currently.Objective　To explore the content construction of dementia management in community health service institutions，in order to provide evidence for future dementia management in community.Methods　From August 2018 to January 2019，the core group of the project was first established to initially formulate indicators for the community management of dementia.And then 28 experts including general practitioners and nurses were selected from the Department of Neurology，Department of Psychiatry，Department of Geriatrics，General Department，and communities.After two rounds of expert consultation using the Delphi method，the authoritative degree，coordination coefficient and positive coefficient were applied for evaluation，and finally the indicator system of the content of dementia management in community was established.Results　The positive coefficients of the experts in two rounds of consultation were 100%，and the mean authoritative degree of first-level indicators was 0.729.The expert coordination coefficients of the importance of evaluation indicators in two rounds of consultation were 0.130 and 0.179（P<0.01），and the expert coordination coefficients of the feasibility were 0.195 and 0.207（P<0.01）.The indicator system of the content of dementia management in community included two first-level indicators，seven second-level indicators，and 20 third-level indicators.The two first-level indicators were the identification and screening of dementia and its follow-up management.The seven second-level indicators were the screening for cognitive performance，the assessment through cognitive screening scale，the referral during screening，the frequency of follow-ups，the content of clinical follow-ups，the scale assessment，and the referral during follow-up.Conclusion　Experts have a high degree of enthusiasm and authority，and after two rounds of consultation，the opinions of experts tend to be consistent.The opinions of experts are in good coordination and the results are credible.The content of dementia management in community constructed by Delphi method provides reference for the future community management of dementia.