基于PRECEDE模式探讨基层医疗机构取消头孢菌素常规皮试的影响因素

Analysis on the Influencing Factors of Abolishing Routine Skin Tests for Cephalosporins in Primary Medical Institutions by PRECEDE Model

关键词:  PRECEDE  头孢菌素  皮肤试验  影响因素  合理用药

Key words:  PRECEDE  cephalosporin  skin test  influence factors  rational drug use

摘要:

目的 探讨阻碍基层卫生院、村站、诊所践行取消头孢菌素常规皮试的影响因素,以期为推进基层医疗机构践行取消头孢菌素常规皮试提供一些对策借鉴,继而进一步促进基层医疗机构抗菌药物的合理使用。方法 基于PRECEDE模式将阻碍践行取消头孢菌素类抗菌药物常规皮试的影响因素分为倾向因素、促成因素和强化因素；自制问卷,并借助问卷星对成都市郫都区全区卫生院、村站、诊所的医生、护士、药师进行一项横断面调查。结果 本次调查共回收问卷459份,其中有效问卷453份,有效率为98.69%。453名医务人员的倾向因素总分为11.67±2.54,其中知识得分为2.39±1.06,态度得分为9.28±2.27；促成因素得分为11.39±4.41；强化因素得分为11.68±3.93。t检验结果显示：倾向于取消头孢菌素常规皮试的医务人员促成因素与强化因素得分更低,差异具有统计学意义(P <0.001)。医务人员对“取消头孢菌素常规皮试”态度的单因素分析显示,倾向于取消头孢菌素常规皮试的比例为16.78%。Fisher确切概率法结果显示：不同年龄段、不同执业场所、不同学历、不同职称的医务人员对“取消头孢菌素常规皮试” 的态度,差异有统计学意义(P＜0.05)。Logistic回归分析显示,学历为大专、本科及以上、倾向因素态度得分越高、促成因素、强化因素得分越低的医务人员,越倾向于取消头孢菌素常规皮试(P＜0.05)。结论 医院管理部门可充分考虑倾向因素、促成因素、强化因素等三大因素对践行取消头孢菌素常规皮试的积极作用；以此将更有针对性的制定干预措施,实施精准干预；继而进一步推进基层医疗机构践行取消头孢菌素的常规皮试,提高抗菌药物的合理使用。

Abstract:

ABSTRACT: OBJECTIVE To investigate the factors that hinder the elimination of routine cephalosporin skin tests in primary healthcare centers, village clinics, and other outpatient facilities, aiming to provide strategic insights for advancing the cancellation of such routine skin tests and, in turn, further enhance the rational use of antimicrobials in these settings. METHODS Based on the PRECEDE model, the influencing factors that impede the cancellation of routine cephalosporin skin tests were categorized into predisposing factors, enabling factors, and reinforcing factors. A self-administered questionnaire was developed and administered to conduct a cross-sectional survey among doctors, nurses, and pharmacists in health centers, village stations, and clinics in Pidu District, Chengdu City, using Wenjuanxing. RESULTS A total of 459 questionnaires were collected, with 453 valid responses, yielding an effective response rate of 98.69%. The total predisposing factor score among the 453 healthcare professionals was 11.67±2.54, comprising a knowledge score of 2.39±1.06 and an attitude score of 9.28±2.27. The enabling factor score was 11.39±4.41, and the reinforcing factor score was 11.68±3.93. T-test results indicated that healthcare professionals who favored eliminating routine cephalosporin skin tests had significantly lower enabling and reinforcing factor scores (P < 0.001). Univariate analysis of attitudes towards "eliminating routine cephalosporin skin tests" revealed that 16.78% of respondents were in favor of this practice. According to Fisher's exact test, significant differences in attitudes were observed among healthcare professionals of different age groups, workplaces, educational backgrounds, and professional titles (P< 0.05). Logistic regression analysis showed that those with college or higher education, higher predisposing factor attitude scores, and lower enabling and reinforcing factor scores were more likely to support eliminating routine cephalosporin skin tests (P< 0.05). CONCLUSION The hospital management department should focus on the positive effects of predisposing factors, enabling factors and reinforcing factors on phasing out cephalosporin skin test, and formulate targeted measures to implement precise intervention, further promote primary hospitals phasing out cephalosporin skin test and promote rational use of antibiotics. KEY WORDS: PRECEDE; cephalosporin; skin test; influence factors; rational drug use