基于IMB模型的肺部疾病肿瘤标志物检测行为调查
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摘要
目的·探讨临床医生对肺部疾病肿瘤标志物检测行为的影响因素及作用路径,以期找出促进医生优化肿瘤标志物检测方案的方法与措施。方法·2017年7月24日至2017年8月10日期间,以上海和北京两地为主,邀请各级医院有处方权且有意愿的临床医生参与肺部疾病肿瘤标志物检测方案影响因素的调查。基于IMB模型的经典理论框架,提出临床医生肿瘤标志物检测行为的IMB理论模型;利用SPSS 24.0软件进行统计描述和关联性分析,借助AMOS 24.0软件进行IMB理论模型的验证和修正。结果·动机因素中,个人意向(r=0.251,P=0.000)和个人利益保护(r=0.178,P=0.007)与信息因素呈现显著正相关;个人意向(P=0.000)和个人利益保护(P=0.013)对行为技巧有显著正向作用,行为技巧对检测行为有显著正向作用(P=0.000)。未见信息因素对行为技巧的直接影响,且未见动机因素对检测行为有直接影响,行为技巧在动机因素对检测行为的影响中起中介作用。结论·较高比例的肺部疾病肿瘤标志物不合理检测提示了不适宜检测的普遍性,其改善有待政府、医院、医生和患者等多方的共同努力。
Objective·To explore the influencing factors and pathways of clinicians' tumor marker prescription behavior in lung diseases, so as to find out the methods and measures to promote clinicians to optimize the tumor marker prescription. Methods·From July 24, 2017 to August 10, 2017, clinicians with willingness and the right of prescription mainly from hospitals in Shanghai and Beijing were invited to participate in survey on influencing factors of tumor marker prescription behavior in lung diseases. Based on the classical theoretical framework of IMB model, an IMB theoretical model of clinicians' tumor marker detection behavior was proposed. Statistical description and correlation analysis were performed by SPSS 24.0, and the IMB theoretical model was validated and corrected by AMOS 24.0. Results·The personal intention(r=0.251, P=0.000) and personal interest protection(r=0.178, P=0.007) had a significant positive correlation with information. Meanwhile, the personal intention(P=0.000) and personal interest protection(P=0.013) had a significant positive effect on behavioral skills, and the behavioral skills had a significant positive effect on tumor marker prescription behavior(P=0.000). There was no direct effect of information on behavioral skills, and motivation had no direct effect on tumor marker prescription behavior. Behavioral skills played a mediating role in the process of motivation influencing the tumor marker prescription behavior. Conclusion·The large percentage of irrational tumor marker prescription in lung diseases suggests the universality of inappropriate testing, which needs the joint efforts of governments, hospitals, clinicians and patients on improvement.
Objective·To explore the influencing factors and pathways of clinicians' tumor marker prescription behavior in lung diseases, so as to find out the methods and measures to promote clinicians to optimize the tumor marker prescription. Methods·From July 24, 2017 to August 10, 2017, clinicians with willingness and the right of prescription mainly from hospitals in Shanghai and Beijing were invited to participate in survey on influencing factors of tumor marker prescription behavior in lung diseases. Based on the classical theoretical framework of IMB model, an IMB theoretical model of clinicians' tumor marker detection behavior was proposed. Statistical description and correlation analysis were performed by SPSS 24.0, and the IMB theoretical model was validated and corrected by AMOS 24.0. Results·The personal intention(r=0.251, P=0.000) and personal interest protection(r=0.178, P=0.007) had a significant positive correlation with information. Meanwhile, the personal intention(P=0.000) and personal interest protection(P=0.013) had a significant positive effect on behavioral skills, and the behavioral skills had a significant positive effect on tumor marker prescription behavior(P=0.000). There was no direct effect of information on behavioral skills, and motivation had no direct effect on tumor marker prescription behavior. Behavioral skills played a mediating role in the process of motivation influencing the tumor marker prescription behavior. Conclusion·The large percentage of irrational tumor marker prescription in lung diseases suggests the universality of inappropriate testing, which needs the joint efforts of governments, hospitals, clinicians and patients on improvement.
引文
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[16]吴明隆.问卷统计分析实务[M].重庆:重庆大学出版社,2010:208,244.
[17]赵耐青.临床医学研究设计和数据分析[M].上海:复旦大学出版社,2005:293-295.
[18]张文彤,董伟.SPSS统计分析高级教程(第2版)[M].北京:高等教育出版社,2013:217-219.
[19]吴明隆.结构方程模型:AMOS的操作与应用[M].重庆:重庆大学出版社,2009:37-62.
[20]胡宏伟,高敏,赵英丽,等.过度医疗行为研究述评[J].社会保障研究,2013(1):46-53.
[2]刘鑫,张国俊.肿瘤标志物联合检测在肺癌诊断中的临床价值及过度医疗[J].中国现代医学杂志,2012,22(34):38-41.
[3]王麟,陈和益,严瑛.肺癌诊断中肿瘤标志物的过度医疗及其措施[J].青岛大学医学院学报,2008,44(2):133-138.
[4]靳凤娣.过度检查、过度治疗的交强险赔付问题初探[J].法制经纬,2010,11(2):11-12.
[5]Gion M,Franceschini R,Rosin C,et al.An epidemiology-based model to estimate the rate of inappropriateness of tumor marker requests[J].Clin Chem Lab Med,2014,52(6):889-897.
[6]李德玲.过度医疗的成因与对策[J].医学与哲学,2003,24(9):5-9.
[7]韩玉珍,王琨,郑锴.公立医院过度医疗根源及对策浅析[J].中国医院管理,2010,30(9):10-11.
[8]Fisher JD,Fisher WA.Changing AIDS-risk behavior[J].Psychol Bull,1992,111(3):455-474.
[9]Osborn CY,Egede LE.Validation of an information-motivation-behavioral skills model of diabetes self-care(IMB-DSC)[J].Patient Educ Couns,2010,79(1):49-54.
[10]吴静雅.基于信息—动机—行为技巧模型的医生处方基本药物行为研究[D].合肥:安徽医科大学,2015.
[11]中华医学会检验分会.肿瘤标志物的临床应用建议[J].中华检验医学杂志,2012,35(2):103-116.
[12]中华医学会呼吸病学分会肺癌学组,中国肺癌防治联盟.原发性支气管肺癌早期诊断中国专家共识(草案)[J].中华结核和呼吸杂志,2014,37(3):172-176.
[13]慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[14]支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015,37(1):433-436.
[15]Fryer AA,Smellie WSA.Managing demand for laboratory tests:a laboratory toolkit[J].Clin Pathol,2013,66:62-72.
[16]吴明隆.问卷统计分析实务[M].重庆:重庆大学出版社,2010:208,244.
[17]赵耐青.临床医学研究设计和数据分析[M].上海:复旦大学出版社,2005:293-295.
[18]张文彤,董伟.SPSS统计分析高级教程(第2版)[M].北京:高等教育出版社,2013:217-219.
[19]吴明隆.结构方程模型:AMOS的操作与应用[M].重庆:重庆大学出版社,2009:37-62.
[20]胡宏伟,高敏,赵英丽,等.过度医疗行为研究述评[J].社会保障研究,2013(1):46-53.
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