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目的调查甘肃省皋兰县乡镇卫生院医务人员的临床决策依据,探讨其临床决策的科学性及合理性。方法自行设计乡镇卫生院医务人员临床决策依据调查问卷,对该县7所卫生院108位医务人员进行现场调查,问卷内容包括被调查者基本情况、临床决策依据的一般情况和被调查者的临床决策与当前最佳临床证据的对比情况三部分。结果共发放调查问卷108份,收回有效问卷89份。调查结果显示:79%的乡镇卫生院医务人员对患者作出诊断和治疗的主要依据为医学教科书;53%的医务人员在选择诊疗方案时最先考虑疗效;33%的医务人员在作临床决策时未能很好地考虑患者的意愿和价值观;52%的乡镇卫生院医务人员针对常见病与多发病制定的临床诊疗方案与BMJ出版的《临床证据》一书中推荐的最佳证据不符。结论当前乡镇卫生院医务人员进行临床决策时未能利用最佳临床证据和充分考虑患者的意愿及价值观,亟需在基层推广循证医学理念,传播最佳临床证据。
Objective To investigate the clinical decision-making basis of medical staff in Gaolan County township hospitals in Gansu Province and to explore the scientific and rationality of clinical decision-making. Methods A questionnaire based on the clinical decision-making of medical personnel in township hospitals was designed. A total of 108 medical staff from 7 hospitals in the county were surveyed on site. The contents of the questionnaire included the basic conditions of the respondents, the general conditions of clinical decision-making, Decision-making and the best clinical evidence of the current situation in three parts. Results A total of 108 questionnaires were distributed and 89 valid questionnaires were returned. Survey results show that: 79% of township hospitals medical staff diagnosis and treatment of patients based mainly on medical textbooks; 53% of the medical staff in the selection of treatment programs to consider the efficacy of the first; 33% of the medical staff in making clinical decisions The patient’s wishes and values were not well considered; 52% of township health workers’ clinical treatment programs for common and frequently occurring diseases did not match the best evidence recommended by BMJ in Clinical Evidence. Conclusions At present, when medical personnel in township hospitals are not able to make use of the best clinical evidence and fully consider the patients’ wishes and values, it is urgent to promote the evidence-based medicine concept at the grass-roots level to disseminate the best clinical evidence.