全科医生对多重用药及潜在不适当用药的知信行现状研究

摘要： 背景 在社区，老年人多重用药及潜在不适当用药（PIM）现象较为普遍，目前针对患者方面的研究较多，针对全科医生知识-信念-行为（KAP）方面的研究较少。 目的 了解北京市城区全科医生在老年人多重用药及PIM方面的知识、态度、行为情况，为改善老年人多重用药及PIM提供参考。 方法 采取方便抽样方法，于2022年8月，选取在全科医生岗位工作并具有独立处方权的全科医生为研究对象。在"2020年北京市家医团队长师资骨干训练营群"等微信群中发放电子问卷进行横断面调查。最后筛选出150名来自北京市城区85家社区卫生服务中心的全科医生作为本研究的样本，对全科医生老年人多重用药及PIM相关KAP进行评分，问卷各部分最终总得分按照百分制计算，百分制得分=实际得分/总分×100；按照传统及格线60分为界分为两组：≥60分组和<60分组。 结果 150名全科医生中，老年人多重用药及PIM知识水平得分<60分140名，≥60分10名；用药态度得分≥60分142名，<60分8名；处方行为得分≥60分115名，<60分35名。知识水平：<60分组和≥60分组年龄、性别、学历、职称、中西医岗位、工作年限、是否参加过用药培训比较，差异均无统计学意义（P>0.05）。用药态度：<60分组和≥60分组年龄、性别、学历、职称、中西医岗位、工作年限、是否参加过用药培训比较，差异均无统计学意义（P>0.05）。处方行为：<60分组和≥60分组性别、学历、职称、中西医岗位、是否参加过用药培训比较，差异无统计学意义（P>0.05）；年龄及工作年限比较，差异有统计学意义（P<0.05）。 结论 北京市城区社区全科医生对老年人多重用药及PIM的态度积极，但知识水平待提高，处方行为有优化空间。应在此方面加强继续教育，提高认知水平，进一步优化处方行为，同时提高PIM管理水平，对老年人进行药物相关教育，以期在改善老年人多重用药及PIM方面发挥积极作用。

关键词: 潜在不适当用药, 全科医生, 多重用药, 知信行

Abstract:

Background

Polypharmacy and potentially inappropriate medication (PIM) are common among older adults. While current research has extensively focused on patient-related aspects, studies concerning general practitioners' knowledge, attitudes, and practice (KAP) in this regard remain limited.

Objective

This study aimed to investigate general practitioners' KAP regarding polypharmacy and PIM in older adults in urban Beijing, and to provide references for improving medication management in this population.

Methods

Employing a convenient sampling approach, we conducted a cross-sectional survey among general practitioners with independent prescribing authority in urban Beijing in August 2022. Electronic questionnaires were distributed through WeChat-based platforms targeting primary care practitioners. After screening, 150 respondents from 85 community health service centers were included in the final analysis. Participants were evaluated on their KAP related to polypharmacy and PIM in older adults. Scores for each domain were converted to a percentage system (calculated as actual score divided by total possible score × 100) and were categorized into two groups based on the conventional pass criterion of 60 points: ≥60 and <60.

Results

Among the 150 general practitioners, the knowledge scores regarding polypharmacy and PIM in the elderly were below 60 in 140 participants and as 60 or above in 10. In terms of medication attitudes, 142 scored as or above 60 and 8 scored under 60. Regarding prescribing behaviors, 115 scored as or above 60 and 35 scored under 60. The scoring distribution (≥60 and <60) for knowledge or medication attitudes showed no statistically significant differences (P>0.05) when being compared among participants in terms of age, gender, education level, professional title, Traditional Chinese Medicine (TCM) Practitioner or Medical Doctor (MD) position, years of practice, or participation in medication training. For the scoring distribution (≥60 and <60) for prescribing behaviors, no significant differences (P>0.05) were found among participants regarding gender, education level, professional title, type of clinical practice (TCM or MD), or training attendance. However, significant differences (P<0.05) in scoring distribution (≥60 and <60) were identified among participants in terms of age and years of practice.

Conclusion

General practitioners in urban community settings demonstrate positive attitudes toward the management of polypharmacy and PIM among elderly patients. However, their knowledge remains inadequate, and prescribing behaviors show potential for improvement. There is hence a compelling need to enhance their continuing medical education focused on geriatric pharmacotherapy. Furthermore, efforts should be made to strengthen the management of PIM and to provide medication-related education for older adults. These measures are expected to facilitate the management of polypharmacy and PIM in the aging population.

Key words: Potentially inappropriate medication, General practitioners, Polypharmacy, Knowledge, attitudes, and practice

引用本文

白瑞瑞,路孝琴,杜凤东. 全科医生对多重用药及潜在不适当用药的知信行现状研究[J]. 中国全科医学, 2026, 29(07): 907-913.