Development of the General Practitioner Management of Age-related Hearing Loss System

doi:10.12114/j.issn.1007-9572.2022.0310

Abstract

Abstract:

Background

The prevalence of age-related hearing loss is increasing gradually as population aging advances in China. Untreated hearing loss is strongly associated with many adverse health events. Age-related hearing loss is difficult to be detected due to slow progression of symptoms, and its harmfulness is often underestimated or neglected. General practitioners (GPs) in primary care could play a vital role in early screening, timely referral and health education management regarding age-related hearing loss.

Objective

To formulate an GP management of age-related hearing loss system, promoting secondary prevention and management of this illness in primary health care.

Methods

By use of literature review and semi-structured reviews, we developed the first draft of General Practitioner Management of Age-related Hearing Loss System from April to June 2021. For reviewing the draft, we conducted a two-round e-mail-based consultation with a purposive sample of 15 experts (engaging in the field of otolaryngology, general practice, administrative management or public health management) from August to November 2021. Then we calculated the response coefficient, authority coefficient and Kendall's Wfor the two consultations, assessed the weights of indicators using analytic hierarchy process, checked the logical consistency of indicators, and determined the final draftof age-related hearing loss management system.

Results

The first draft of General Practitioner Management of Age-related Hearing Loss System consisted of 6 primary indicators and 15 secondary indicators. The response coefficient was 100.0% for both consultations. The expert authority coefficient was 0.877 for the first round of consultation, and 0.920 for the second round. Kendall's W coefficients were 0.428 (χ²=89.821, P<0.001) , and 0.307 (χ²=87.387, P<0.001) , respectively for the first and second rounds of consultations. The final system consists of 6 primary indicators (theoretical knowledge of age-related hearing loss, screening skills for age-related hearing loss, referral ability of age-related hearing loss, ability to diagnose and treat ear diseases, ability to manage adverse events of age-related hearing loss, doctor-patient communication ability) , and 20 secondary indicators. The mean value of importance for all indicators was above 8.000, the coefficient of variation of all indicators was above 0.250, and the full score ratio of all indicators was above 30.0%. The weights of the above-mentioned six primary indicatorswere 0.082, 0.082, 0.082, 0.077, 0.077, and 0.077, respectively. The consistency ratio of primary and secondary indicators was 0.063 5, 0.043 2, respectively (<0.100 0) .

Conclusion

The response and authority coefficients, and Kendall's W coefficients of the consultations were high, suggesting that the consultation results were scientific, credible and reliable. This system can be used as a guidance system for secondary prevention and management of this illness by GPs in primary care.

Key words: Age-related hearing loss, Management index system, General practitioners, Community health services, Semi-structured interview, Delphi method

摘要：

背景

随着我国人口老龄化程度的加深，年龄相关性听力损失发病率逐步增高，未经治疗的听力损失和诸多不良健康事件的发生密切相关。由于症状进展缓慢，老年听力损失不易被发现，其危害常被低估和忽视。基层全科医生可在听力损失患者的早期筛查、及时转诊、健康教育管理等方面发挥重要作用。

目的

构建基于全科医生的年龄相关性听力损失管理指标体系，推动基层听力损失二级预防和管理。

方法

于2021年4—6月，通过文献回顾、半结构式访谈，初步确立基于全科医生的年龄相关性听力损失管理指标体系。采用目的抽样法，于2021年8—11月邀请15例专家（来自耳鼻喉专科、全科医学、行政管理、公共卫生管理领域）作为函询对象，对其进行两轮函询，通过计算专家积极系数、专家权威系数、专家协调系数，并采用层次分析法评价各级指标权重、检验各级指标逻辑一致性，最终确定指标体系。

结果

初步构建的基于全科医生的年龄相关性听力损失管理指标体系由6个一级指标、15个二级指标组成。两轮专家函询问卷的有效回收率均为100.0%，专家权威系数分别为0.877、0.920，Kendall's W系数分别为0.428（χ²=89.821，P<0.001）、0.307（χ²=87.387，P<0.001）。最终确立的指标体系由6个一级指标（年龄相关性听力损失理论知识、年龄相关性听力损失筛查技能、年龄相关性听力损失转诊能力、耳科常见疾病的诊治能力、年龄相关性听力损失不良事件管理能力、医患沟通能力）和20个二级指标构成。所有指标的重要性赋值均数均>8.0分，变异系数均<0.250，满分比均>30.0%。6个一级指标的权重分别为0.082、0.082、0.082、0.077、0.077、0.077，各层级指标的一致性比率分别为0.063 5、0.043 2。

结论

参与函询的专家积极性、权威程度较高，意见较为集中；专家函询结果具备一定的科学性、可信度和可靠度。构建的指标体系可为基层全科医生年龄相关性听力损失二级预防和管理工作提供指导与参考。

GE Jianli,GENG Shasha,CHEN Xin, et al. Development of the General Practitioner Management of Age-related Hearing Loss System[J]. Chinese General Practice, 2022, 25(34): 4318-4325. DOI: 10.12114/j.issn.1007-9572.2022.0310.
葛剑力,耿莎莎,陈昕等. 基于全科医生的年龄相关性听力损失管理指标体系构建研究[J]. 中国全科医学, 2022, 25(34): 4318-4325. DOI: 10.12114/j.issn.1007-9572.2022.0310.

Figures/Tables 2

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项目		例数	构成比（%）
性别
	男	7	46.7
	女	8	53.3
年龄（岁）
	35~44	1	6.7
	45~54	10	66.7
	55~64	4	26.7
最高学历
	本科	4	26.7
	硕士研究生	9	60.0
	博士研究生	2	13.3
专业技术职称
	中级	2	13.3
	副高级	11	73.3
	高级	2	13.3
工作单位
	医疗卫生机构	11	73.3
	教学科研机构	4	26.7
专业领域
	耳鼻喉专科	5	33.3
	全科医学	6	40.0
	行政管理	2	13.3
	公共卫生管理	2	13.3
专业工作年限（年）
	10~19	1	6.7
	20~29	11	73.3
	30~39	3	20.0

项目		例数	构成比（%）
性别
	男	7	46.7
	女	8	53.3
年龄（岁）
	35~44	1	6.7
	45~54	10	66.7
	55~64	4	26.7
最高学历
	本科	4	26.7
	硕士研究生	9	60.0
	博士研究生	2	13.3
专业技术职称
	中级	2	13.3
	副高级	11	73.3
	高级	2	13.3
工作单位
	医疗卫生机构	11	73.3
	教学科研机构	4	26.7
专业领域
	耳鼻喉专科	5	33.3
	全科医学	6	40.0
	行政管理	2	13.3
	公共卫生管理	2	13.3
专业工作年限（年）
	10~19	1	6.7
	20~29	11	73.3
	30~39	3	20.0

一级指标	二级指标	重要性赋值（±s，分）	CV	满分比（%）	权重	组合权重
年龄相关性听力损失理论知识	定义	10.0	0	100.0	0.048	0.004
	高危因素	10.0	0	100.0	0.048	0.004
	干预措施	9.9±0.4	0.036	86.7	0.047	0.004
	治疗手段	9.9±0.4	0.036	86.7	0.047	0.004
	不良后果及并发症^a	9.9±0.3	0.026	93.3	0.047	0.004
年龄相关性听力损失筛查技能	纯音测听	9.3±0.5	0.052	33.3	0.042	0.003
	老年人听力障碍量表及筛查版	9.4±0.5	0.054	40.0	0.042	0.003
年龄相关性听力损失转诊能力	转诊指征判断	9.5±0.5	0.055	46.7	0.043	0.004
	转诊通道建立	9.3±0.5	0.052	33.3	0.042	0.003
耳科常见疾病的诊治能力	常规耳道镜检查	9.5±0.5	0.055	46.7	0.043	0.003
	外耳道疾病基本判断及诊治	9.3±0.5	0.052	33.3	0.042	0.003
	中耳炎基本判断及诊治	9.4±0.5	0.054	40.0	0.043	0.003
年龄相关性听力损失不良事件管理能力	认知功能减退的早期筛查	9.3±0.6	0.064	33.3	0.039	0.003
	情绪障碍的早期筛查	9.3±0.5	0.052	33.3	0.042	0.003
	其他不良事件的预防指导^a	9.4±0.5	0.054	40.0	0.043	0.003
	患者家庭成员的照护指导^a	9.5±0.5	0.055	46.7	0.043	0.003
	老年人群听力随访指导^a	9.5±0.6	0.068	53.3	0.043	0.003
医患沟通能力	提高耳聋患者对助听器使用依从性	9.3±0.5	0.052	33.3	0.042	0.003
	提高老年人听力筛查依从性	9.4±0.5	0.054	40.0	0.043	0.003
	改善听力损失对医患沟通造成的影响^a	9.6±0.5	0.053	60.0	0.045	0.003

一级指标	二级指标	重要性赋值（±s，分）	CV	满分比（%）	权重	组合权重
年龄相关性听力损失理论知识	定义	10.0	0	100.0	0.048	0.004
	高危因素	10.0	0	100.0	0.048	0.004
	干预措施	9.9±0.4	0.036	86.7	0.047	0.004
	治疗手段	9.9±0.4	0.036	86.7	0.047	0.004
	不良后果及并发症^a	9.9±0.3	0.026	93.3	0.047	0.004
年龄相关性听力损失筛查技能	纯音测听	9.3±0.5	0.052	33.3	0.042	0.003
	老年人听力障碍量表及筛查版	9.4±0.5	0.054	40.0	0.042	0.003
年龄相关性听力损失转诊能力	转诊指征判断	9.5±0.5	0.055	46.7	0.043	0.004
	转诊通道建立	9.3±0.5	0.052	33.3	0.042	0.003
耳科常见疾病的诊治能力	常规耳道镜检查	9.5±0.5	0.055	46.7	0.043	0.003
	外耳道疾病基本判断及诊治	9.3±0.5	0.052	33.3	0.042	0.003
	中耳炎基本判断及诊治	9.4±0.5	0.054	40.0	0.043	0.003
年龄相关性听力损失不良事件管理能力	认知功能减退的早期筛查	9.3±0.6	0.064	33.3	0.039	0.003
	情绪障碍的早期筛查	9.3±0.5	0.052	33.3	0.042	0.003
	其他不良事件的预防指导^a	9.4±0.5	0.054	40.0	0.043	0.003
	患者家庭成员的照护指导^a	9.5±0.5	0.055	46.7	0.043	0.003
	老年人群听力随访指导^a	9.5±0.6	0.068	53.3	0.043	0.003
医患沟通能力	提高耳聋患者对助听器使用依从性	9.3±0.5	0.052	33.3	0.042	0.003
	提高老年人听力筛查依从性	9.4±0.5	0.054	40.0	0.043	0.003
	改善听力损失对医患沟通造成的影响^a	9.6±0.5	0.053	60.0	0.045	0.003