Page 98 - 2022-34-中国全科医学

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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 W
for 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
2
consultation，and 0.920 for the second round. Kendall's W coefficients were 0.428（χ =89.821，P<0.001），and 0.307
2
（χ =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

老龄化是二十世纪后期以来我国最为突出的人口变 议。澳大利亚一项队列研究发现，至全科医生处就诊的
化趋势之一。2016 年一项针对我国四省份听力障碍流 年龄相关性听力损失患者中，只有不到半数的人被转诊
行现况的调查发现，≥ 60 岁老年人听力损失患病率为 并接受了进一步治疗 ［12］ 。造成这种状况的原因可能包
64.7%，听力障碍患病率达 34.1%。2018 年世界卫生组 括：全科医生数量较少且日常工作负荷较重、对全科医
织数据显示，约 1/3 的≥ 65 岁老年人存在中度及以上 生开展听力筛查和干预培训的力度不足及全科医生多关
的听力损失 ［1-4］ 。年龄相关性听力损失是一个缓慢而渐 注对居民生命健康造成严重威胁的健康问题等 ［15-16］ 。
进的过程，未经治疗的听力损失和诸多不良健康事件的 目前，国内部分基层医疗卫生机构已尝试开展耳和听力
发生密切相关，如情绪障碍、失能、阿尔茨海默病等， 保健模式建设，为辖区内高血压、糖尿病患者及接受健
甚至会增加老年人全因死亡风险，并导致其医疗保健成 康体检的居民提供耳部疾病筛查、建档、初步治疗或转
本和利用率增加 ［5-8］ 。年龄相关性听力损失常被认为是 诊服务 ［17］ ，相关工作取得了一定成效。但纵观国内，
自然现象，加之老年人平均收入不高，而相关的治疗设 对于年龄相关性听力损失尚缺乏行之有效、同质化的管
备（如助听器、人工耳蜗）虽已逐步得到认可和推广 ［9］ ， 理指标体系及完善的转诊模式与制度 ［18］ 。考虑到管理
但价格仍偏高，上述因素导致年龄相关性听力损失患者 指标体系的构建将有助于保障基层年龄相关性听力损失
积极寻求医疗帮助的意愿较低 ［8，10］ 。现有证据表明， 管理工作的规范化开展，并实现考核工作的标准化、同
年龄相关性听力损失患者从发现听力损失到寻求听力干 质化，本研究通过构建基于全科医生的年龄相关性听力
预平均延迟 8~9 年 ［11］ 。 损失管理指标体系，旨在为基层全科医生早期识别、规
随着我国分级诊疗制度的不断推进，全科医生逐 范化管理年龄相关性听力损失患者提供参考，为基层医
渐成为社区居民健康的首诊人。老年人群是社区健康 疗卫生机构耳和听力保健模式的顺利开展奠定基础。
管理和慢性病管理的重点人群。年龄相关性听力损失 1 对象与方法
作为一种常见慢性病，其定期筛查、早期识别、及时 1.1 形成基于全科医生的年龄相关性听力损失管理指
干预和随访管理尚未在基层得到广泛开展并受到全科 标体系初稿 于 2021 年 4 月，以“年龄相关性听力
医生的充分重视 ［12-13］ ，且大多数年龄相关性听力损失 损失”“老年性耳聋”“听力筛查”为中文检索词，
患者仍首选至综合医院耳鼻喉专科接受诊治和随访。 以“age-related hearing loss”“presbycusis”“hearing
WALLHAGEN 等 ［14］ 的研究结果显示，多达 85% 的老 screening”为英文检索词，计算机检索万方数据知识服
年患者报告未从全科医生处得到有关听力损失管理的建 务平台、Web of Science 数据库，获取有关年龄相关性