基层医疗医生对心房颤动的知识、态度和实践：研究生培训的潜在作用。
Knowledge, attitude, and practice regarding atrial fibrillation among primary care physicians: the potential role of postgraduate training.
作者信息
Ooi Phaik Choo, Ramayah Gogilavendan, Omar Syahril Rizwan, Rajadorai Vilasini, Nadarajah Thatsheila, Ting Chung Hui, Teng Cheong Lieng
机构信息
MBBS (UM), MAFP/FRACGP, Community Based Department Universiti Kuala Lumpur, Royal College of Medicine Perak, Ipoh, Perak, Malaysia. email:
MBBS, MAFP/FRACGP, Buntong Health Clinic, Ipoh, Perak, Malaysia.
出版信息
Malays Fam Physician. 2021 Feb 7;16(1):39-49. doi: 10.51866/oa0002. eCollection 2021 Mar 25.
INTRODUCTION
Atrial fibrillation (AF) is known to lead to stroke and thromboembolism, causing a five-fold increase in the risk of stroke and almost doubling the mortality rate. Optimal anticoagulant therapy is effective in reducing AF-related death. However, prescription of anticoagulants in AF in East Asian countries has been low, ranging from 0.5% to 28%. This study aimed to determine whether vocational training in family medicine improves primary care physicians' knowledge, attitude, and practice in the management of AF.
METHOD
This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM).
RESULTS
A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p < 0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy).
CONCLUSION
Vocational training in family medicine appears to improve primary care physicians' knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.
引言
已知心房颤动（AF）会导致中风和血栓栓塞，使中风风险增加五倍，死亡率几乎翻倍。最佳抗凝治疗可有效降低与房颤相关的死亡风险。然而，东亚国家房颤患者的抗凝药物处方率一直较低，在0.5%至28%之间。本研究旨在确定家庭医学职业培训是否能提高基层医疗医生在房颤管理方面的知识、态度和实践能力。
方法
本调查是一项横断面研究，在为两组学员举办的集中研讨会上进行，使用经过验证的问卷：（i）初级学员是新入学的家庭医学研究生证书（GCFM）项目的研究生学员，（ii）高级学员是马来西亚家庭医生学会（AFPM）家庭医学高级培训（ATFM）项目的研究生学员。
结果
共有223名学员（127名初级学员和96名高级学员）参与了本研究。只有55.2%的学员通过了知识测试；与初级学员相比，高级学员通过知识测试的可能性更大（69.8%对44.1%，p<0.001）。女性学员通过知识测试的可能性明显高于男性学员。虽然初级和高级学员的态度相似，但后者中有更多人在提供更好支持的公立诊所工作，那里对门诊抗凝治疗有更好的支持（例如，当日国际标准化比值（INR）检测、直接获取超声心动图以及内部药房提供华法林）。
结论
家庭医学职业培训似乎能提高基层医疗医生关于房颤管理的知识。更好的知识将有助于经过职业培训的基层医疗医生在基层医疗诊所为房颤患者提供抗凝治疗。如果解决了已确定的障碍并实施共享护理计划，基层医疗中可以实现更优化的房颤管理。
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