本文關(guān)鍵詞： 精神障礙 指南 指南研究與評(píng)價(jià)Ⅱ 評(píng)價(jià) 應(yīng)用 實(shí)施　出處：《上海交通大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：【目的】（1）評(píng)價(jià)國(guó)內(nèi)精神障礙臨床指南的方法學(xué)質(zhì)量。（2）初步探索國(guó)內(nèi)部分地區(qū)《精神分裂癥防治指南》實(shí)施應(yīng)用的現(xiàn)況。 【方法】（1）檢索中國(guó)知識(shí)資源總庫(kù)、中國(guó)科技期刊數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)檢索系統(tǒng)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、PubMed及國(guó)內(nèi)指南相關(guān)網(wǎng)站，并且結(jié)合同行專(zhuān)家建議輔以手動(dòng)檢索，收集國(guó)內(nèi)精神障礙相關(guān)臨床指南。按照預(yù)先制定的納入、排除標(biāo)準(zhǔn)對(duì)檢索結(jié)果予以篩選，對(duì)所獲國(guó)內(nèi)精神障礙臨床指南，按照指南研究與評(píng)價(jià)（Appraisal of Guidelines for Research and Evaluation, AGREE）Ⅱ?qū)ζ溥M(jìn)行方法學(xué)質(zhì)量評(píng)價(jià)。同時(shí)檢索PubMed、BMJ Best Practice、Web of Science、DynaMed(EBSCO)等數(shù)據(jù)庫(kù)，以及美國(guó)國(guó)家指南交換中心、英國(guó)國(guó)家衛(wèi)生與臨床優(yōu)化研究院、蘇格蘭學(xué)院際指南網(wǎng)絡(luò)、國(guó)際指南網(wǎng)絡(luò)等指南網(wǎng)站，收集國(guó)外精神分裂癥、焦慮障礙、心境障礙有關(guān)的臨床指南，對(duì)其進(jìn)行AGREEⅡ評(píng)價(jià)，并與國(guó)內(nèi)此三類(lèi)精神障礙臨床指南作質(zhì)量比較。（2）采用自編《精神分裂癥防治指南》應(yīng)用現(xiàn)況調(diào)查問(wèn)卷，通過(guò)方便取樣，在我國(guó)部分地區(qū)對(duì)臨床一線精神科醫(yī)師進(jìn)行無(wú)記名問(wèn)卷調(diào)查。 【結(jié)果】(1)共獲得15個(gè)符合納入標(biāo)準(zhǔn)的國(guó)內(nèi)精神障礙臨床指南，其發(fā)表時(shí)間2006-2012年，開(kāi)發(fā)組織主要為中華醫(yī)學(xué)會(huì)。15個(gè)國(guó)內(nèi)精神障礙臨床指南AGREEⅡ各領(lǐng)域的中位數(shù)標(biāo)準(zhǔn)化得分顯示，陳述清晰性（76%）及范圍和目的(76%）領(lǐng)域最高；參與人員（41%）和應(yīng)用性（40%）領(lǐng)域較低；開(kāi)發(fā)嚴(yán)謹(jǐn)性（30%）和編輯獨(dú)立性（3%）領(lǐng)域最低。國(guó)外臨床指南的檢索與篩選，共獲得國(guó)外精神分裂癥指南12個(gè)，焦慮障礙指南22個(gè)，心境障礙指南32個(gè)。12個(gè)精神分裂癥指南，其6個(gè)領(lǐng)域的標(biāo)準(zhǔn)化得分中位數(shù)依次為92%、60%、70%、90%、31%、54%；22個(gè)焦慮障礙指南，6個(gè)領(lǐng)域標(biāo)準(zhǔn)化得分中位數(shù)分別為92%、53%、63%、88%、24%、46%；32個(gè)心境障礙指南，6個(gè)領(lǐng)域標(biāo)準(zhǔn)化得分中位數(shù)分別為86%、58%、61%、92%、24%、63%。精神分裂癥、焦慮障礙、心境障礙有關(guān)指南國(guó)內(nèi)、外比較，除應(yīng)用性領(lǐng)域無(wú)統(tǒng)計(jì)學(xué)差異，其它5個(gè)領(lǐng)域國(guó)內(nèi)指南得分均較國(guó)外指南低。（2）《精神分裂癥防治指南》應(yīng)用現(xiàn)況的調(diào)查，共回收問(wèn)卷325份，有效問(wèn)卷318份，有效率97.8%。81.1%調(diào)查醫(yī)師表示知道該指南，其中讀過(guò)指南的醫(yī)師占72.1%（占總有效調(diào)查人數(shù)58.5%），讀過(guò)的醫(yī)師中96.2%在實(shí)踐中參照指南，，且多數(shù)醫(yī)師是部分參照。主要的指南實(shí)施阻礙因素：缺乏對(duì)指南的宣傳（63.2%），缺乏對(duì)指南的理解（62.6%），多個(gè)指南之間缺乏共識(shí)、存在分歧（58.2%），缺乏與指南實(shí)施相適應(yīng)的國(guó)家政策(54.7%)。促進(jìn)指南實(shí)施的措施主要為：分發(fā)簡(jiǎn)易版指南（70.3%）、促進(jìn)國(guó)家政策與指南相適應(yīng)（55.5%）、利用地方醫(yī)學(xué)會(huì)進(jìn)行培訓(xùn)和推廣（53.6%）。 【結(jié)論】(1)國(guó)內(nèi)精神障礙臨床指南的方法學(xué)質(zhì)量，總體上與AGREE Ⅱ標(biāo)準(zhǔn)相差較大，尤其編輯獨(dú)立性、開(kāi)發(fā)嚴(yán)謹(jǐn)性、應(yīng)用性領(lǐng)域。今后國(guó)內(nèi)精神障礙臨床指南的開(kāi)發(fā)或更新，需更多地參考AGREE Ⅱ。(2)國(guó)內(nèi)部分地區(qū)《精神分裂癥防治指南》的實(shí)施情況不理想，需采取全面措施促進(jìn)指南的實(shí)施應(yīng)用。
[Abstract]:[Objective] (1) to evaluate the methodological quality of the clinical guidelines for mental disorders in China. (2) to explore the current application of schizophrenia prevention and treatment guidelines in some areas of China.
[Methods] (1) Chinese retrieval knowledge resources database, Chinese journals database, Wanfang Data retrieval system, Chinese biomedical literature database, PubMed and guide domestic related websites, and with peer recommendations with manual retrieval, collection of domestic mental disorders. Clinical guidelines in accordance with pre established inclusion and exclusion criteria for retrieval results to the screening, the domestic mental disorders clinical guidelines for research and evaluation, in accordance with the guidelines (Appraisal of Guidelines for Research and Evaluation, AGREE) on the methodological quality evaluation. At the same time BMJ Best search PubMed, Practice, Web of Science, DynaMed (EBSCO) database, and the national guide exchange center the British National Institute for health and clinical excellence, Scotland Institute of international guide network, international network guide guide website, collect foreign schizophrenia, anxiety Disorder, mood disorder clinical guidelines on the evaluation of the AGREE II, and compare the quality and clinical guidelines of China the three types of mental disorders. (2) by using the self-designed "schizophrenia prevention guide > application status questionnaire by convenient sampling, an anonymous questionnaire survey was conducted on clinical psychiatrists in part area of our country.
[results] (1) received a total of 15 domestic clinical guidelines met the inclusion criteria of mental disorders, the publication time of 2006-2012 years, the main organization for the development of Chinese Medical Association in various fields.15 clinical guidelines for domestic mental disorders of AGREE median standardized score showed that a clear statement of scope and purpose (76%) and (76%) the highest in the field; (41%) and (40%) the application field is low; the development of rigor (30%) and editorial independence (3%). The lowest field retrieval and screening of foreign clinical guidelines, received a total of 12 foreign schizophrenia guidelines, anxiety disorders, mood disorders guide 22, guide 32.12 a guide to schizophrenia, the median standardized score in 6 areas were 92%, 60%, 70%, 90%, 31%, 54%; 22 anxiety disorder guide, 6 areas of standardization of the median score were 92%, 53%, 63%, 88%, 24%, 46%; 32 mood disorders guide, 6 collar Domain standard median score were 86%, 58%, 61%, 92%, 24%, 63%., schizophrenia, anxiety disorders, mood disorders related to guide domestic, outside, in addition to the application field of no significant difference, the other 5 areas to guide domestic scores compared with foreign guide low. (2) survey "schizophrenia the application of the guidelines for prevention and treatment", a total of 325 copies of questionnaires, 318 valid questionnaires, a survey of physicians know the efficiency of the 97.8%.81.1% guide, which read guide physicians accounted for 72.1% (the total number of research, 58.5%) 96.2% read physicians in practice according to guidelines, and most physicians are part of the reference. The main factors hindering the implementation of guidelines: lack of publicity guide (63.2%), lack of understanding of the guide (62.6%), a lack of consensus among a plurality of guide, there are differences (58.2%), and the lack of implementation guidelines to adapt to the national policy (54.7%). A Guide to promoting the implementation of the measures The main features are: the distribution of simple guide (70.3%), the promotion of national policies and guidelines (55.5%), and the use of local medical societies for training and promotion (53.6%).
[Conclusion] (1) methods clinical guidelines for mental disorders domestic quality, with the overall AGREE II standard difference, especially the development of editorial independence, rigor, application fields. The future domestic clinical guidelines of mental disorders developed or updated, need more reference AGREE II. (2) the implementation of the spirit of parts < > split guide domestic disease control is not ideal, need to take comprehensive measures to promote the implementation of the application guidelines.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R749

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 田梅;張勇;白珍;楊彩儒;劉艷芳;李慧敏;馬磊;楊淑恩;張國(guó)強(qiáng);史彥彥;;城鄉(xiāng)居民精神衛(wèi)生知識(shí)知曉率調(diào)查[J];中國(guó)健康心理學(xué)雜志;2011年02期

2 陳瑩;;廈門(mén)市居民精神衛(wèi)生知識(shí)知曉率調(diào)查[J];中國(guó)健康心理學(xué)雜志;2011年10期

3 李春波,何燕玲,張明園;一致性檢驗(yàn)方法的合理應(yīng)用[J];上海精神醫(yī)學(xué);2000年04期

4 陳可冀;蔣躍絨;;中醫(yī)和中西醫(yī)結(jié)合臨床指南制定的現(xiàn)狀與問(wèn)題[J];中西醫(yī)結(jié)合學(xué)報(bào);2009年04期

5 趙威;高煒;王貴松;;急性ST段抬高心肌梗死臨床指南知曉率及應(yīng)用情況調(diào)查[J];心肺血管病雜志;2007年02期

本文編號(hào)：1503669