目的 探讨线上线下规范化培训模式在基层医师急性心肌梗死(acute myocardial infarction,AMI)诊疗中的价值。方法 选取2021年2月1日至2021年7月31日在四川省20家网络联盟基层医疗机构接受AMI诊断和溶栓-转运治疗策略培训的60名基层医师作为研究对象,采用随机数字表将20家医疗机构分为试验组和对照组,每组有10家基层医疗机构及其30名基层医师。试验组采用线上线下规范化培训,对照组采用常规面对面培训。收集两组医师的培训接受度和满意度,评价基层医师接诊的230例AMI患者的诊疗及预后效果。采用卡方检验或Fisher确切概率法进行统计分析。结果 试验组医师比对照组医师对培训的接受度高[100.0%(30/30)比80.0%(24/30),P=0.021]和满意度高[96.7%(29/30)比73.3%(22/30),P=0.030]。与对照组医师诊疗的AMI患者比较,试验组医师接诊的AMI患者规范化溶栓-转运比例更高[77.8%(70/90)比33.3%(25/75),P<0.001];规律抗血小板治疗比例[100.0%(120/120)比94.5%(104/110),P=0.031],抗心室重塑治疗中β-受体阻滞剂[83.3%(100/120)比54.5%(60/110),P<0.001]、血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂[75.0%(90/120)比45.5%(50/110),P<0.001]使用比例更高;30天随访期间临床复合心血管不良事件发生率更低[9.2%(11/120)比19.1%(21/110),P=0.031]。结论 本研究的开展为基层医师提供了个体化、精准化的线上培训与线下指导,促进了基层医疗机构AMI规范化救治与管理水平的提升。
Objective To investigate the learning outcomes of online to offline standardized training in the diagnosis and management of acute myocardial infarction (AMI). Methods A total of 60 primary care doctors (PCD) who received AMI diagnosis and thrombolytic-transport treatment strategy training in 20 network alliance medical institutions in Sichuan Province from February 1, 2021 to July 31, 2021 were selected as the research objects. The medical institutions were divided into 10 experimental group and 10 control group by random number table with 30 trainees in each group. The online to offline standardized training program was used in the experimental group while the classic offline training was used in the control group. The training acceptance and satisfaction of PCD were collected. The diagnosis, treatment and prognosis of 230 patients with AMI treated by PCD were also evaluated. Chi square test or Fisher exact probability method was used for statistical analysis. Results The comparison of acceptance of the training [100.0% (30/30) vs. 80.0% (24/30), P=0.021] and of satisfaction [96.7% (29/30) vs. 73.3%(22/30), P=0.030] between the two groups showed a significant difference. Compared with AMI patients treated by PCD in the control group, the proportion of standardized thrombolysis-transport in AMI patients treated by PCD in the experimental group was significantly higher [77.8%(70/90) vs. 33.3%(25/75), P<0.001].The standardized antiplatelet[100.0%(120/120) vs. 94.5%(104/110), P=0.031], and anti-ventricular remodeling therapy with β-blockers [83.3%(100/120) vs. 54.5% (60/110), P<0.001];angiotensin converting enzyme inhibitor / angiotensin II receptor blocker [75.0%(90/120) vs.45.5%(50/110), P<0.001] ratio from the two groups also showed significant difference. The incidence of clinical composite cardiovascular adverse events was less in experimental group during a 30-day follow-up [9.2 % (11/120) vs. 19.1 % (21/110), P=0.031]. Conclusions This study provided an individualized and target-oriented hybrid online / offline training method for primary care physicians and promoted the standardized treatment and management of AMI in primary care institutions.
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