【作者】 刘文彬；

【导师】 张新平；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 目的:在总结国内外参与式培训有益经验的基础上,探讨合理用药参与式培训干预策略的理论依据及其合理用药促进效果,为其在我国的推广提供依据。研究内容包括:(1)国内外合理用药参与式培训的实践情况;(2)实施合理用药参与式培训的理论依据;(3)医学生合理用药参与式培训的干预实践研究。方法:(1)通过文献法总结合理用药参与式培训的理论依据和国内外实践情况;(2)通过专家法,组织专家对干预实践的课题设计和调查工具进行论证,确保研究方案的科学性和可行性。(3)干预实践研究实施策略:①干预对象:同济医学院04、05级临床、预防、药学三个专业的医学生;②干预方案:本次合理用药参与式培训具体采取了小组报告、讨论学习和直接参与合理用药干预的形式,分三个阶段进行:第一阶段,通过面向04级、05级医学生的小课题招标,确定了直接参与合理用药小课题的医学生(即直接参与组);第二阶段,指导直接参与组的医学生进行各自的课题研究,并将研究结果总结、报告,相互讨论学习;第三阶段,指导直接参与课题者对目标人群(即被动接受宣教组)进行合理用药行为干预。③资料收集、分析:本研究采用问卷调查的方式,通过对各期用药知识、观念、行为的考核,评价合理用药干预效果。干预活动开始前,采用随机抽样方法,Ⅰ期调查开展合理用药宣教班级的学生119人;干预活动开始后,按干预方式分为直接参与组和被动接受宣教组,对两组分别进行抽样调查:Ⅱ期采取随机抽样方法,在干预活动刚结束时调查直接参与组38人、被动接受宣教组59人;Ⅲ期采取随机抽样方法,在干预完全结束后一个月调查直接参与组45人、被动接受宣教组62人。运用描述性统计方法对干预对象的合理用药知识、观念、行为情况进行描述;对直接参与组、被动接受宣教组两组同期的知识得分比较采用两独立样本的t检验,对此两组各自的前后三期比较,采用F检验。对观念、行为各指标,直接参与组、被动接受宣教组两组同期比较采用Wilcoxon秩和检验;两组各自的前后比较采用H检验。结果与结论:对同济医学院学生开展合理用药相关培训,并进行问卷调查,结果显示:在用药知识方面,干预前直接参与组与被动接受宣教组的用药知识平均得分分别为15.48分、14.79分,二者干预前的知识水平差异无统计学意义(t=1.653,P=0.102);干预刚结束,直接参与组与被动接受宣教组的用药知识平均得分分别为15.91分、15.76分,二者在用药知识水平上的差异无统计学意义(t=0.466,P=0.642);在干预结束后一个月,直接参与组与被动接受宣教组的用药知识平均得分分别为16.06分、15.07分(t=2.102,P=0.038),用药知识水平差异有统计学意义,提示参与式培训方法与一般宣教方法相比,用药知识水平的提高效果较持久。在用药观念方面,干预刚结束,直接参与组与被动接受宣教组在用药观念上的差异无统计学意义;在干预结束后一个月,直接参与组的问卷回答情况与被动接受宣教组相比,在有关药物危害的A17题(药品名一字之差,效果可完全不同)和有关使用方式的A25题(对于能口服的药品,就尽量不用注射)回答情况的差异有统计学意义(Z值分别为2.036、2.531,P值分别为0.042、0.011),其余各题回答情况的差异无统计学意义(所有P>0.05)。以上结果说明干预后,采用参与式培训的直接参与组对药物危害和使用方式的认知水平高于被动接受宣教组。在用药行为方面,干预前和干预刚结束,直接参与组与被动接受宣教组在用药行为上的差异无统计学意义;在干预结束后一个月,直接参与组的问卷回答情况与被动接受宣教组相比,在有关接受他人合理用药建议的P35题(若他人指出您用药行为的不合理之处,您是否乐意接受)回答情况的差异有统计学意义(Z=2.560,P=0.010),其余各题回答情况差异无统计学意义(所有P>0.05)。以上结果说明经干预后,采用参与式培训的直接参与组比被动接受宣教组更倾向于接受他人的合理用药建议。可见,参与式培训方法对合理用药知识、观念、行为方面的干预效果较一般培训方式优越,尤其体现在用药知识改变上,而且干预效果较持久;同时,在认知药物危害、接受他人合理用药建议等用药观念、行为的特定方面也有显著改观。建议:1.将合理用药教育纳入现有课程体系由于对合理用药的教育不足,医学生在用药知识、观念、行为上与合理用药的标准存在一定差距。要从根本上提高用药知识水平、树立合理用药的观念、促进药物合理使用,就必须将合理用药教育制度化,长期化。2.进一步开展合理用药参与式培训的实践与研究(1)借鉴相关领域干预经验,促进参与式培训方法运用(2)扩大干预范围,尤其要加强对卫生服务需方的干预(3)深入分析探讨研究环境中的重要影响因素(4)合理选用具体干预方式(5)干预效果评价设计进一步严密(6)加强对教育培训成果宣传并辅以配套措施本研究的创新之处:在合理用药教育中引入了一种新的培训方法——参与式培训法;培训针对的是一类特殊的卫生服务需方、也即未来的卫生服务供方——医学生,对他们进行干预使其从医学教育阶段就树立良好的用药观念,将对今后的合理用药教育起到事半功倍的效果。本研究的不足之处在于,干预时间较短暂,前后只有一个半月,而观念、行为等方面的改变需要一个过程,这就使一些变化无法在干预期间或问卷调查期间被发现。更多还原

【Abstract】 ObjectivesBased on the result analysis of the practice of participatory training promoting rational use of drugs both at home and abroad, the study aimed at:To evaluate the effect of the drug use among the medical students.To discuss the soundness of the related theories that support the intervention strategy of participatory training activities implemented to enhance the rational use of drugs.To make suggestion and provide theoretical support to the promotion of the intervention strategy of participatory training activities aiming to enhance the rational use of drugs.Content1. The study of the practice of participatory training both at home and aboard aiming at promoting rational use of drug. 2. Theoretical study of participatory training aiming at promoting rational use of drug. 3. The study of the practice of intervention participatory training designed to increase the rational use of drugs among the medical students.Methods1. Literature review: Summarizing the theories and intervention experience both at home and aboard of participatory training promoting rational use of drug.2. DELPHI: by inviting expert commenting the design of the intervention study and questionnaires, the feasibility and rightness of the study was ensured.3. The strategy on carrying out the intervention study (1) Objects: Sophomores and juniors majoring in clinical medicine, pharmacology and preventive medicine were selected.(2) Intervention plan: Two methods, participatory training and common training, were carried out. The process study was divided into three periods: first, by free bidding of the mini research to the students, the students who directly participated in the mini study of rational use of drugs were determined. Then, the determined students were assisted to finish the mini research about the RUD. The result would be summarized and discussed. At last, the direct participants would be guided to execute intervention of RUD on the behavior of the experimental group.(3) Data collection and analysis: A questionnaire survey was adopted to evaluate the intervention effects. Objects were chosen by random sampling. 119 students were randomly sampled at the baseline survey. According to the baseline condition, 38 students in participatory mode and 59 students in common mode were randomly surveyed at the ending of the participatory training. 45 students in participatory mode and 62 students in common mode were randomly surveyed one month after the ending of the participatory training.Descriptive statistics method was used in describing the knowledge, attitude, practice of the RUD of the objects, the score difference in the knowledge between the participatory mode and the common mode at the same period were tested by two independent t-test, the difference among all the three periods of each of them were tested by variance analysis.For the indicators of attitude and practice, the score difference between the participatory mode and the common mode at the same period were tested by Wilcoxon rank sum t-test, the difference among all the three periods of each of them were tested by H-test.Results and ConclusionsBefore and after the intervention, the questionnaire surveys were carried out to evaluate the effect of the intervention. The results show that:In the aspect of the knowledge of RUD, before the intervention, the mean score of the participatory mode and the common mode were 15.48 and 14.79, indicating no significant difference between them(t=1.653,P=0.102). At the ending of the intervention, the mean score of the participatory mode and the common mode, were 15.91 and 15.76, indicating no significant difference between them(t=0.466,P=0.642). However, one month after the ending of the intervention, the mean score of the two modes were 16.06 and 15.07, demonstrating significant difference between them(t=2.102,P=0.038). It showed that: In the aspect of the knowledge of RUD, intervention effect of the participatory mode would last longer than the common mode.In the aspect of the attitude of RUD, no significant difference was found between the participatory mode and the common mode at the ending of the intervention. But one month after the ending of the intervention, there was significant difference between the participatory mode and the common mode at the item A17“the effect could be absolutely different with difference of one word”, which was about the hazard of the drug (Z=2.036, P=0.042) and item A25“If some drug can be oral, you had better not take them by injection”, which was about the taking-method (Z=2.531, P=0.011). No significant differences were found in all the other items. The result revealled the fact that: Comparing to the common mode, the awareness of the drug hazard and the taking-method of the participatory mode had improved after the intervention.In the aspect of the practice of RUD, there was no significant difference between the participatory mode and the common mode before and at the ending of the intervention. But one month after the ending of the intervention, there was significant difference between the participatory mode and the common mode at the item P35“If someone point out that your irrational use of drug, are you willing to accept?”which concerned the will of accepting the others’advice of RUD (Z=2.560, P=0.010). It can be concluded from the result that: after the intervention, the medical students taking the participatory training were more willing to accept the others’advice of RUD.Generally speaking, participatory training method showed edges over the common training method in training outcome. The difference in training outcome was substantial after a long period, especially in the aspect of the knowledge of RUD. Also, there was significant change in certain aspects of the attitude and practice of RUD, such as the awareness of the drug hazard, accepting the others’advice of RUD.Suggestions 1. Adding the RUD education to the current course system.The study found that the awareness, attitude and behavior of the RUD of medical students had fallen well below the requirements of the RUD. The blame was taken primary on the lacking of the RUD courses in the curriculum portfolios.Also, without a sustainable and institutionalized education plan of the RUD, it was unlikely to obtain the major goals such as boost the knowledge, increase the awareness and better the behavior of the RUD.2. Deepening the practice and study of the participatory training on the RUD:(1) Using the intervention experience of relevant aspect for reference to boost the use of the participatory training.(2) Enlarging the range of the intervention, especially strengthen the intervention on the demander of the health service.(3) Further the discussions of the key influencing factors in the research circumstances.(4) Rigorously designed research method.(5) Enhancing the promotion of the achievement obtained in participatory training and ensuring the outcome with related measures.Innovations in this Study1. Having introduced a new training method, the participatory training in the RUD education. 2. The study focused on particular demanders of the health service (the medical students), who are likely to be the health service providers in the future. The intervention has helped them establish the concept of RUD during the period of the medicine education. The great effect will gradually take place as they become health service personnel.However, some drawback was unavoidable in the study: the experiment lasted only 1.5 months, not long enough to observe the full attitude and behavior transitions of the participants. Besides, some item concerning in the questionnaire may not be easy to detect.更多还原