中国全科医学 ›› 2024, Vol. 27 ›› Issue (05): 604-611.DOI: 10.12114/j.issn.1007-9572.2023.0283

• 论著·用药指导 • 上一篇    

基于德尔菲法初步编制门诊慢性病患者参与用药安全能力自评量表

冯郑文, 陈小垒, 李卉, 朱宸立, 邵爽, 杜娟*()   

  1. 100069 北京市,首都医科大学全科医学与继续教育学院
  • 收稿日期:2023-03-08 修回日期:2023-07-15 出版日期:2024-02-15 发布日期:2023-11-21
  • 通讯作者: 杜娟

  • 作者贡献:冯郑文、杜娟提出主要研究目标,负责研究的构思与设计,研究的实施,撰写论文;冯郑文、陈小垒、李卉、朱宸立进行数据的收集与整理,统计学处理;邵爽、杜娟进行论文的修订;杜娟负责文章的质量控制与审查,对文章整体负责,监督管理。
  • 基金资助:
    北京市教育委员会科研计划项目(SZ202110025009)

Preliminary Development of Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety Based on the Delphi Method

FENG Zhengwen, CHEN Xiaolei, LI Hui, ZHU Chenli, SHAO Shuang, DU Juan*()   

  1. School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China
  • Received:2023-03-08 Revised:2023-07-15 Published:2024-02-15 Online:2023-11-21
  • Contact: DU Juan

摘要: 背景 患者用药安全已成为世界关注的医疗卫生问题,患者对于促进自身用药安全发挥着重要作用。 目的 基于德尔菲法初步编制门诊慢性病患者参与用药安全能力自评量表,为评估及促进门诊慢性病患者参与用药安全能力提供客观标准。 方法 通过文献研究和半结构化访谈法拟定门诊慢性病患者参与用药安全能力量表初始条目。根据研究目的,采用德尔菲法对来自北京、上海、广东、天津、浙江、内蒙古的28名专家进行两轮函询,请专家对量表各维度的熟悉程度及判断依据进行评分,采用Likert 5级评分法对条目重要性及可行性进行评分。2021-09-30—10-12进行第一轮专家咨询,2021-11-05—15进行第二轮专家咨询,最后通过专家小组会议讨论确定最终条目。计算问卷回收率,以此反映专家积极性;采用权威系数衡量咨询结果的权威程度;采用变异系数及协调系数Kendall's W评价专家意见协调程度;重要性和可行性评分的算术均数≥3.5分且变异系数<0.25作为条目筛选的初步参考,同时结合专家意见,经研究小组成员和专家小组会议充分讨论后确定条目调整结果。 结果 两轮专家咨询均发出28份问卷,回收问卷28份,专家积极系数均为100%。两轮咨询专家权威系数为0.877。第二轮条目重要性和可行性的专家意见协调系数Kendall's W相较第一轮均有所提高。第一轮专家咨询结果显示,各条目重要性评分为3.964~4.964分,变异系数为0.038~0.211;可行性评分为3.964~4.821分,变异系数为0.081~0.265。第二轮专家咨询结果显示,各条目的重要性评分为4.321~5.000分,变异系数为0~0.168;可行性评分为4.036~4.893分,变异系数为0.064~0.186。两轮专家咨询及专家小组会议后最终确定了包括用药知识、用药信念、参与用药决策、用药自我管理4个维度、33个条目的门诊慢性病患者参与用药安全能力自评量表。 结论 本研究构建了一个包含用药知识、用药信念、参与用药决策、用药自我管理4个维度、33个条目的门诊慢性病患者参与用药安全能力自评量表,该自评量表能够对门诊慢性病患者参与用药安全能力进行评估,为制订相应措施以促进患者参与用药过程、提高用药安全提供参考。

关键词: 慢性病, 病人参与, 用药安全, 自我评价, 德尔菲技术

Abstract:

Background

Patient medication safety has become a global priority in healthcare, and patients play an important role in promoting their own medication safety.

Objective

To develop a Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety based on the Delphi method and provide objective criteria for assessing and promoting their abilities to participate in medication safety.

Methods

A literature review and semi-structured interviews were used to formulate the initial entries of scale for the ability of outpatients with chronic diseases to participate in medication safety. According to the study objectives, 28 experts from Beijing, Shanghai, Guangdong, Tianjin, Zhejiang, and Inner Mongolia participated in two rounds of correspondence using the Delphi method, and were asked to rate their familiarity and judgement basis of the dimensions, and the importance and feasibility of the items were rated using a five-point Likert scale. The first round of expert correspondence was conducted from 30 September to 12 October 2021, and the second round was conducted from 5 to 15 November 2021. Final items of the scale were determined through an expert panel discussion. The questionnaire recovery rate was calculated as a reflection of expert motivation; the degree of authority of the correspondence results was measured using the authority coefficient; the degree of coordination of expert opinions was evaluated using the coefficient of variation and the coordination coefficient Kendall's W. The arithmetic mean of importance and feasibility scores≥3.5 and coefficient of variation<0.25 were used as the initial reference for items selection, the adjustments of the items were decided after the thorough discussions among the members of research team and the expert panel combining with the opinions of experts.

Results

In both rounds of correspondence, 28 questionnaires were sent out and 28 questionnaires were returned, with a positive coefficient of 100% and the expert authority coefficient of 0.877. The expert coordination coefficient Kendall's W of the importance and the feasibility of items in the second round of correspondence increased compared to the first round of correspondence. The mean importance scores of items in the two rounds of the consultation ranged from 3.964 to 4.964 and 4.321 to 5.000, with coefficients of variation from 0.038 to 0.211 and 0 to 0.168. The mean feasibility scores of the items in the two rounds of the consultation ranged from 3.964 to 4.821 and 4.036 to 4.893, with coefficients of variation from 0.081 to 0.265 and 0.064 to 0.186, respectively. The final Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety was determined after two rounds of expert correspondence and an expert panel discussion, including 4 dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items.

Conclusion

A Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety containing four dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items, was constructed in the study, which can assess the ability of outpatients with chronic diseases to participate in medication safety and provide a reference for developing appropriate measures to promote patient participation in the medication process and improve medication safety.

Key words: Chronic diseases, Patient participation, Medication safety, Self-evaluation, Delphi technique