基于COM-B理论基层医师抗菌药物静脉输液处方行为的影响因素  

Influencing factors of prescription behavior of antimicrobial intravenous in-fusion among grassroots physicians based on COM-B theory

作　　者：汪庆 沈帆 刘成宝 李颖[1] WANG Qing;SHEN Fan;LIU Chengbao;LI Ying(Clinical Pharmacy Room,the First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Province,Hefei230031,China;Department of Medical Administration,Feixi County Health Commission,Anhui Province,Feixi231200,China;Public Health Center,Feixi County Sanhe Hospital,Anhui Province,Feixi231221,China)

机构地区：[1]安徽中医药大学第一附属医院临床药学室,安徽合肥230031 [2]安徽省肥西县卫生健康委员会医政科,安徽肥西231200 [3]安徽省肥西县三河医院公卫中心,安徽肥西231221

出　　处：《中国医药导报》2024年第31期100-107,共8页China Medical Herald

基　　金：中国药学会-施维雅青年医院药学创新研究资助项目(CPA-B04-ZC-2021-001);安徽省卫生健康科研项目-恒瑞创新药物研究专项(AHWJ2023BAc10045)。

摘　　要：目的基于COM-B理论探讨基层医师抗菌药物静脉输液处方行为的影响因素,为基层医疗机构抗菌药物静脉输液干预管理提供依据。方法采用目的性抽样方法,于2023年10月25日至30日选取以安徽省合肥市肥西县12家乡镇卫生院在岗临床医师为研究对象,收集相关数据。基于COM-B理论设计调查问卷,采用结构方程模型对理论假设进行检验。结果实际发放问卷435份,有效回收340份,有效回收率为78.16%。量表整体Cronbach’sα系数为0.938,KMO值为0.939,具有较好的结构效度、聚敛效度和组合信度,各维度间的相关系数均小于平均方差抽取量平方根,区分效度理想。在路径分析方面,除知识、技能、环境资源和社会影响对动机调节关系不显著外,其他路径均关系显著,各链式中介效应显著(P<0.05)。结论结构方程模型可较好地解释基层医师抗菌药物静脉输液处方行为的影响因素,提示应培养和营造基层医师的相关能力和机会,通过动机的中介作用促进处方行为的改善,从而推动基层医疗机构抗菌药物静脉输液行为的健康可持续发展。Objective To explore the influencing factors of prescription behavior of antimicrobial intravenous infusion among grassroots physicians based on COM-B theory,and to provide a basis for the intervention and management of antibiotic intravenous infusion in grassroots medical institutions.Methods The purposive sampling method was used to select clinical physicians on duty at 12 township health centers in Feixi County of Hefei City in Anhui Province in 25th to 30th October 2023 as the research subjects.Relevant data was collected.A survey questionnaire was designed based on COM-B theory.Theoretical hypothesis was tested by using structural equation model.Results A total of 435 questionnaires were distributed,and 340 valid questionnaires were recovered,with an effective recovery rate of 78.16%.The overall Cronbach’sαof the scale was 0.938,and KMO value was 0.939,indicated good structural validity,convergent validity and composite reliability.The correlation coefficients between dimensions were all less than the square root of the average variance extracted,indicated ideal discriminant validity.In the path analysis,except for the insignificant relationship between knowledge,skills,environmental resources,and social influence on motivation regulation,all other pathways had significant relationships,and the chain mediation effects were also significant(P<0.05).Conclusion Structural equation model can effectively explain the influencing factors of the prescription behavior of antibacterial intravenous infusion by grassroots physicians.It is suggested to cultivate and create the relevant abilities and opportunities of grassroots physicians,promote the improvement of prescription behavior through the mediating effect of motivation,and thus promote the healthy and sustainable development of antibacterial intravenous infusion behavior in grassroots medical institutions.

关 键 词：COM-B 基层医师 抗菌药物静脉输液 处方行为 影响因素 结构方程模型 

分 类 号：R95[医药卫生—药学]