本文關鍵詞： 精神障礙 指南 指南研究與評價Ⅱ 評價 應用 實施　出處：《上海交通大學》2014年碩士論文　論文類型：學位論文

【摘要】：【目的】（1）評價國內精神障礙臨床指南的方法學質量。（2）初步探索國內部分地區(qū)《精神分裂癥防治指南》實施應用的現況。 【方法】（1）檢索中國知識資源總庫、中國科技期刊數據庫、萬方數據檢索系統(tǒng)、中國生物醫(yī)學文獻數據庫、PubMed及國內指南相關網站，并且結合同行專家建議輔以手動檢索，收集國內精神障礙相關臨床指南。按照預先制定的納入、排除標準對檢索結果予以篩選，對所獲國內精神障礙臨床指南，按照指南研究與評價（Appraisal of Guidelines for Research and Evaluation, AGREE）Ⅱ對其進行方法學質量評價。同時檢索PubMed、BMJ Best Practice、Web of Science、DynaMed(EBSCO)等數據庫，以及美國國家指南交換中心、英國國家衛(wèi)生與臨床優(yōu)化研究院、蘇格蘭學院際指南網絡、國際指南網絡等指南網站，收集國外精神分裂癥、焦慮障礙、心境障礙有關的臨床指南，對其進行AGREEⅡ評價，并與國內此三類精神障礙臨床指南作質量比較。（2）采用自編《精神分裂癥防治指南》應用現況調查問卷，通過方便取樣，在我國部分地區(qū)對臨床一線精神科醫(yī)師進行無記名問卷調查。 【結果】(1)共獲得15個符合納入標準的國內精神障礙臨床指南，其發(fā)表時間2006-2012年，開發(fā)組織主要為中華醫(yī)學會。15個國內精神障礙臨床指南AGREEⅡ各領域的中位數標準化得分顯示，陳述清晰性（76%）及范圍和目的(76%）領域最高；參與人員（41%）和應用性（40%）領域較低；開發(fā)嚴謹性（30%）和編輯獨立性（3%）領域最低。國外臨床指南的檢索與篩選，共獲得國外精神分裂癥指南12個，焦慮障礙指南22個，心境障礙指南32個。12個精神分裂癥指南，其6個領域的標準化得分中位數依次為92%、60%、70%、90%、31%、54%；22個焦慮障礙指南，6個領域標準化得分中位數分別為92%、53%、63%、88%、24%、46%；32個心境障礙指南，6個領域標準化得分中位數分別為86%、58%、61%、92%、24%、63%。精神分裂癥、焦慮障礙、心境障礙有關指南國內、外比較，除應用性領域無統(tǒng)計學差異，其它5個領域國內指南得分均較國外指南低。（2）《精神分裂癥防治指南》應用現況的調查，共回收問卷325份，有效問卷318份，有效率97.8%。81.1%調查醫(yī)師表示知道該指南，其中讀過指南的醫(yī)師占72.1%（占總有效調查人數58.5%），讀過的醫(yī)師中96.2%在實踐中參照指南，，且多數醫(yī)師是部分參照。主要的指南實施阻礙因素：缺乏對指南的宣傳（63.2%），缺乏對指南的理解（62.6%），多個指南之間缺乏共識、存在分歧（58.2%），缺乏與指南實施相適應的國家政策(54.7%)。促進指南實施的措施主要為：分發(fā)簡易版指南（70.3%）、促進國家政策與指南相適應（55.5%）、利用地方醫(yī)學會進行培訓和推廣（53.6%）。 【結論】(1)國內精神障礙臨床指南的方法學質量，總體上與AGREE Ⅱ標準相差較大，尤其編輯獨立性、開發(fā)嚴謹性、應用性領域。今后國內精神障礙臨床指南的開發(fā)或更新，需更多地參考AGREE Ⅱ。(2)國內部分地區(qū)《精神分裂癥防治指南》的實施情況不理想，需采取全面措施促進指南的實施應用。
[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.

【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R749

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