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目的了解患者对伏立康唑个体化用药的认知与意愿,探讨参与临床决策时患者的考虑因素,为伏立康唑个体化用药指南的推荐强度的形成提供依据。方法用横断面研究方法,通过问卷的形式在9家医院调查不同类型患者对于伏立康唑治疗药物监测(TDM)及细胞色素2C19(CYP2C19)基因型检测的认知与意愿。结果本研究共纳入119例患者,其中有24例(20.17%)儿童。95例(79.83%)患者认为在治疗真菌感染期间有必要进行伏立康唑TDM,曾经接受过伏立康唑TDM与没有接受过的患者对于接受伏立康唑TDM的意愿存在显著差异(100%vs 75.76%,P<0.05)。有54例(45.38%)患者愿意进行CYP2C19基因型检测,不同医保类型的患者存在显著性差异(P<0.05)。对于患者做出以上2个决策的影响因素排序均有统计学上的一致性(P<0.05),临床有效性均是患者最为看重的因素(秩均值3.46∶3.87),花费(秩均值1.89)和潜在获益(秩均值2.00)分别为伏立康唑TDM和CYP2C19基因型检测对患者临床决策影响最小的因素。结论不同真菌感染患者对伏立康唑TDM及CYP2C19基因型检测的意愿存在较大差异。其可能是临床医师做临床决策的一个重要因素。在临床指南的建立和临床实践过程中应考虑患者的认知与意愿。
Objective To understand the patients’ cognition and willingness to use voriconazole for individualized medication and to explore the factors that should be considered when participating in clinical decision-making, so as to provide basis for the formation of recommendation strength of voriconazole for individualized medication guideline. Methods A cross-sectional study was conducted to investigate the cognition and willingness of different types of patients for the detection of voriconazole-based therapeutic drugs (TDM) and cytochrome 2C19 (CYP2C19) genotypes in nine hospitals by questionnaire. Results A total of 119 patients were enrolled in this study, of which 24 (20.17%) were children. Ninety-five patients (79.83%) considered voriconazole TDM necessary for the treatment of fungal infections. There was a significant difference in willingness to receive voriconazole (100% vs 75.76%, P <0.05) for patients who had been treated with voriconazole compared with those who did not. . In 54 cases (45.38%), the CYP2C19 genotype was willing to be tested. There was a significant difference (P <0.05) among patients of different health insurance types. The ranking of influencing factors for the above two decisions made by patients was statistically significant (P <0.05). The clinical validity was the most important factor (rank 3.46: 3.87), cost (rank 1.89) And potential benefit (mean of 2.00) were the factors that have the least effect on the clinical decision-making of voriconazole TDM and CYP2C19 genotypes, respectively. Conclusion There is a great difference in the willingness of testing voriconazole for TDM and CYP2C19 genotypes among different fungal infections. It may be an important factor for clinicians to make clinical decisions. The patient’s cognition and willingness should be considered during the establishment of clinical guidelines and clinical practice.