糖尿病患者用药偏好及循证决策辅助工具研究  

Study on Patients' Preferences for Anti-diabetic Drugs and the Development of an Evidence-based Decision Aid

作　　者：谢同玲 颜菲菲 张怡 宋冬梅 陈天勇 孟静怡 耿劲松[1] XIE Tongling;YAN Feifei;ZHANG Yi;SONG Dongmei;CHEN Tianyong;MENG Jingyi;GENG Jinsong(Department of Medical Informatics,Medical School of Nantong University,Nantong 226001,China;Information Center,People's Hospital of Rugao,Nantong 226500,China;Changzhou Jiwu Intelligent Technology Co.,LTD,Changzhou 211300,China)

机构地区：[1]南通大学医学院医学信息学系,江苏省南通市226001 [2]如皋市人民医院信息中心,江苏省南通市226500 [3]常州及物智能科技有限公司,江苏省常州市211300

出　　处：《中国全科医学》2024年第33期4105-4111,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(72374113);教育部人文社会科学研究规划基金(21YJAZH023);南通市社会民生科技计划项目(MS12021064)。

摘　　要：背景糖尿病因其高患病率及相关的致残率和死亡率,成为影响健康的重要问题。研究证据为改善患者健康结局提供了有效信息,决策辅助工具利于患者获取证据,增加医患的互动性。目的获取糖尿病患者的用药偏好,开发循证决策辅助工具,以实现证据、患者价值观和决策情境的结合,促成以患者为中心的循证决策。方法检索PubMed、Web of Science核心合集、Embase、Cochrane Library、CINAHL、中国知网、维普网、万方数据知识服务平台,确定降糖药的价值评估维度和属性,文献检索的时限为建库至2022-12-31。采用优劣尺度法设计糖尿病患者的用药偏好问卷,在江苏省5家医院开展实证研究。在分析患者偏好的基础上,运用Vue+Element UI、Spring Boot、Spring Security、Java等技术开发循证决策辅助工具。结果大血管并发症发生率、延长的生命年、生活质量的变化、微血管并发症发生率、糖化血红蛋白的控制这5个属性在糖尿病患者的临床决策中最为重要。循证决策辅助工具提供了降糖新药相对有效性、相对安全性、便捷性和可负担性的结构化证据概要。降糖新药的多维价值评估模块是工具的核心,支持患者对药品价值的循证评估。结论循证决策辅助工具整合了降糖新药的研究证据、患者偏好和价值观,有助于实现医患共同决策。Background Diabetes is an important health problem due to its high prevalence and associated disability and mortality.Research evidence provides effective information for improving patient health outcomes.Decision aids can help patients obtain evidence and increase physician-patient interaction.Objective To obtain patients' preferences for anti-diabetic drugs and develop an evidence-based decision aid to achieve the integration of evidence,patient values,and decision settings,thus facilitating patient-centered evidence-based decision making.Methods Several literature databases,like PubMed,Web of Science Core Collection,Embase,Cochrane Library,Cumulative Index to Nursing and Allied Health Literature(CINAHL),China National Knowledge Infrastructure(CNKI),VIP Chinese Science Journals Database,and Wanfang Data were searched to determine the value assessment dimensions and attributes of anti-diabetic drugs.The time limit for literature search is from the establishment of the database to December 31,2022.The questionnaires for investigating patients' preferences for anti-diabetic drugs were designed using the best-worst scaling method.Then,the empirical study to explore preferences was carried out in five hospitals in Jiangsu Province.Based on the analysis of patients' preferences,an evidence-based decision aid was developed using techniques including Vue + Element UI,Spring Boot,Spring Security,Java,etc.Results The most important five attributes in patient decisions were incidence of macrovascular complications,length of extended life years,change of healthrelated quality of life,incidence of microvascular complications,and control of Hb A1c.The evidence-based decision aid provides a structured summary of evidence on the comparative effectiveness,comparative safety,convenience,and affordability of new anti-diabetic drugs.The multi-attribute value assessment module of new anti-diabetic drugs is the core element of the decision aid,supporting patients' evidence-based assessment of the drugs' value.Conclusion Evidence-bas

关 键 词：糖尿病 降糖药 患者偏好 决策辅助 循证决策辅助工具 

分 类 号：R319[医药卫生—基础医学]