全科医师开具单片复方制剂降压药物处方影响因素的质性研究  

Factors influencing general practitioners prescribing habits of single-pill combination antihypertensive drugs:a qualitative study

作　　者：陈丹翔 谢舒 汪丽 张浩 张艳艳 李雪琴[1] Chen Danxiang;Xie Shu;Wang Li;Zhang Hao;Zhang Yanyan;Li Xueqin(Department of General Practice,Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University,Huai′an 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院全科医学科,淮安223300

出　　处：《中华全科医师杂志》2025年第2期150-155,共6页Chinese Journal of General Practitioners

基　　金：淮安市自然科学生命健康专项软课题(2023KX0007)。

摘　　要：目的探讨全科医师开具单片复方制剂(SPC)降压药物处方的影响因素。方法该研究为质性研究。于2023年4至5月采用目的抽样法抽取江苏省淮安市2家综合医院和4家社区卫生服务中心, 然后进一步在抽取的综合医院和社区卫生服务中心中分别选取4名全科医师作为访谈对象。访谈内容包括个人基本信息、SPC降压药物临床选用原则、患者对SPC降压药物的接受程度、医师对SPC降压药物的评价及其临床使用过程中存在的困难等。采用现场专题小组访谈法进行访谈。访谈结束后整理、归纳访谈记录, 借助NVivo 12软件对文本资料进行逐句编码、归类、提炼主题, 最终形成描述性语言。结果入选江苏省淮安市2家综合医院和4家社区卫生服务中心的全科医师24名作为谈对象, 年龄33~53岁, 男性10名、女性14名, 其中16名来自社区卫生服务中心, 8名来自综合医院。共提炼出关于全科医师开具SPC降压药物处方影响因素的4个主题、9个子主题。主题1为全科医师根据患者的具体情况决定是否开具SPC降压药物处方(血压分级、药物依从性、多重用药等)。主题2为全科医师开具SPC降压药物处方受到价格、调药等因素的影响。主题3为全科医师对开具SPC降压药物处方的态度不同。主题4为社区卫生服务中心的全科医师开具SPC降压药物处方面临较多困难(SPC降压药物品种较少、患者对医师的信任度不一以及处方规范性等)。结论全科医师开具SPC降压药物的影响因素主要包括患者的具体情况、价格、调药、全科医师的态度以及一些临床实际问题。ObjectiveTo investigate the factors influencing the prescribing habits of general practitioners(GPs)in relation to single-pill combination(SPC)antihypertensive drugs.MethodsThis was a qualitative study.Using the purposive sampling method,2 general hospitals(designated as HAZ1-2)and 4 community health service centers(designated as HAS1-4)in Huai′an city,Jiangsu province were selected from April to May 2023.In addition,4 general practitioners(designated as A-D)were selected as interviewees from each general hospital and center.The selected individuals were interviewed using on-site thematic group interviews.The interview mainly included the principles of clinical selection of SPC antihypertensive drugs;the degree of acceptance of SPC antihypertensive drugs by patients after prescription;the evaluation of SPC antihypertensive drugs and the difficulties existing in their clinical use.The data of the interview were analyzed according to the thematic framework.ResultsTwenty-four GPs were interviewed.Four themes and 9 sub-themes were extracted regarding factors influencing GP prescribing of SPC antihypertensive drugs.The study showed that:(1)the prescribing of SPC antihypertensive drugs by GPs according to patients′specific conditions;(2)the prescribing of SPC antihypertensive drugs by GPs was influenced by factors such as price and drug adjustment;(3)the different evaluations of SPC antihypertensive drugs among GPs;(4)GPs in community health service centers faced many difficulties in prescribing SPC antihypertensive drugs(relatively fewer varieties of SPC drugs in the community,lower patient trust in community GPs,and lower standardization of prescribing by community GPs).ConclusionThe factors influencing GPs′prescribing of SPC antihypertensive drugs mainly include the patients′specific situation,price,medication adjustment,attitude of GPs,and some clinical practice problems.

关 键 词：高血压 降压 控制性 全科医师 处方 单片复方制剂 

分 类 号：R54[医药卫生—心血管疾病]