上海社区全科医师对慢性心力衰竭认知现状及影响因素分析

doi:10.16138/j.1673-6087.2022.06.007

摘要/Abstract

摘要：

目的：了解上海社区医院全科医师对慢性心力衰竭（心衰）的认知情况，并分析影响因素，为基层开展心衰防治工作提供科学依据。方法：依据《慢性心力衰竭基层诊疗指南（2019年）》设计调查问卷，问卷内容涉及心衰的定义与流行病学、病因和发病机制、诊断评估、药物治疗、非药物管理5个方面。于2021年5—6月对上海10家社区卫生服务中心在职的全科医师进行问卷调查，收集研究对象的人口学特征，并对心衰知识进行测试，分析对指南的掌握情况和影响因素。结果：共136名医师完成了问卷，平均分为（63.5±11.2）分，及格医师71名（及格率52.2%）；其中关于射血分数保留心衰、3种新型抗心衰药物的使用、心衰易损期和水钠管理方面答题正确率<50.0%，其余各部分答题完全正确率均大于50.0%。有途径咨询心内专科医师、2年内参加过心衰相关培训及学习过2019年版心衰基层指南是全科医师测试及格的影响因素（P<0.05）。结论：上海基层全科医师对慢性心衰知识总体掌握情况较好，但在对射血分数保留的心衰的理解、新型抗心衰药物的使用和心衰患者的综合管理中仍有欠缺。

关键词: 慢性心力衰竭, 全科医师, 问卷调查

Abstract:

Objective To investigate the knowledge depth and breadth of understanding the chronic heart failure in general practitioners in Shanghai community healthcare center, analyze the influencing factors, and to provide a scientific basis for the prevention and treatment of heart failure in the future. Methods Based on the“Guidelines for Primary Diagnosis and Treatment of Chronic Heart Failure (2019)”, a questionnaire was designed, and it covered the definition and epidemiology of heart failure, etiology and pathogenesis, diagnostic evaluation, drug therapy, and non-drug management. The questionnaire was conducted on general practitioners working in 10 community health service centers in Shanghai from May to June 2021, the demographic characteristics of the study subjects was collected, the knowledge depth and breadth of understanding chronic heart failure was investigated, and the influencing factors were analyzed. Results The average score of 136 primary doctors on the knowledge test of heart failure was (63.5±11.2) points, and the pass rate was 52.2%(71/136); in which, the correct rate of understanding the heart failure of preserved ejection fraction, the use of three new anti-heart failure drugs, the vulnerable period of heart failure and the management of water and sodium were less than 50 percent， while the remaining parts was greater than 50.0%. Consulting with a cardiologist, participating the heart failure-related training in past 2 years, and studying the“Guidelines” were independent influencing factors(P<0.05). Conclusions This study showed that the general practitioners in Shanghai overall have a good understanding of chronic heart failure knowledge, but they still need to improve understanding of heart failure of preserved ejection fraction, the use of new anti-heart failure drugs, and the comprehensive management of heart failure patients.

Key words: Chronic heart failure, General practitioner, Questionnaire investigation

中图分类号:

R541.6

张瑞歆, 屈春艳, 蒋婕, 童建菁. 上海社区全科医师对慢性心力衰竭认知现状及影响因素分析[J]. 内科理论与实践, 2022, 17(06): 457-462.

ZHANG Ruixin, QU Chunyan, JIANG Jie, TONG Jianjing. Analysis of knowledge depth and breadth of understanding chronic heart failure in general practitioners in Shanghai and influencing factors[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(06): 457-462.

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问卷条目	错误	部分正确	完全正确
心衰的定义与流行病学（n=544）	176（32.4）	91（16.7）	277（50.9）
心衰的病因和发病机制（n=544）	160（29.4）	33（6.1）	351（64.5）
心衰的诊断与评估（n=816）	188（23.0）	26（3.2）	602（73.8）
心衰的药物治疗（n=1 224）	480（39.2）	30（2.5）	714（58.3）
心衰的非药物管理（n=1 224）	530（43.3）	57（4.7）	637（52.0）

变量	OR	95%CI	P
工作年限（ref=工作<5年）
5~9年	1.177	0.262~5.281	0.831
10~20年	1.542	0.326~7.308	0.585
>20年	2.035	0.367~11.274	0.416
目前职称（ref=初级）
中级	1.222	0.260~5.732	0.800
高级	1.201	0.179~8.059	0.850
每日门诊心衰患者人数（ref=门诊<10人）
>10人	0.896	0.118~6.810	0.915
就职医院是否可行心超检查（ref=否）
是	1.837	0.792~4.264	0.157
就职医院是否可以化验BNP（ref=否）
是	1.873	0.747~4.696	0.181
是否有咨询心内专科医师途径（ref=否）
是	7.482	4.082~15.124	<0.001
两年内是否参加心衰相关学习培训（ref=否）
是	2.758	1.218~6.243	0.015
是否学习2019版心衰指南（ref=否）
是	4.994	2.116~11.784	<0.001