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| 感染患者关于万古霉素治疗药物监测的价值观与意愿调查 |
| Investigation of Values and Preferences in Therapeutic Drug Monitoring of Vancomycin in Infectious Patients |
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| DOI： |
| 中文关键词: 万古霉素 治疗药物监测 指南 意愿 价值观 |
| 英文关键词:Vancomycin Therapeutic drug monitoring Guideline Preferences Values |
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| 中文摘要: |
| 摘 要 目的：探索潜在耐甲氧西林金黄色葡萄球菌(Methicillin resistant Staphylococcus aureus, MRSA)感染患者关于万古霉素治疗药物监测（therapeutic drug monitoring，TDM）的价值观和意愿，并为中国万古霉素治疗药物监测指南的建立提供参考。方法：纳入中国5个省市的潜在MRSA感染的患者，调查其对万古霉素输注方式、是否给予负荷剂量及TDM必要性三项干预措施的的观点。使用视觉模拟评分（Visual Analogue Score，VAS）测量患者在安全、有效、经济、适当等方面评价药物治疗方案和措施的价值观。对于离散型变量和连续型变量分别采用χ2检验和秩和检验。结果：本研究共纳入167名患者，其中有22名（13.17%）儿童。134名（80.24%）患者认为如果存在MRSA感染在治疗期间有必要进行万古霉素TDM，高医保报销比例患者与低医保报销比例患者间认为有必要进行万古霉素TDM的比例差异有统计学意义(65.77%vs55.36%, P<0.05）。有104名（62.28%）患者更倾向于持续输注，儿童与其他人的差异有统计学意义(86.36% vs 58.62%, P<0.05。109名（65.27%）患者倾向于不接受万古霉素负荷剂量。患者对临床疗效的意愿强度为9，肾毒性意愿强度为9，花费意愿强度为5，负担意愿强度为5，其他因素的意愿强度为4。患者的医保类型(中位数5vs6.5, P<0.05）及收入(中位数6 vs 4, P<0.01)可能潜在影响患者在花费方面的价值观。结论：潜在MRSA感染患者对万古霉素治疗及万古霉素TDM的价值观和意愿在不同情况下出现较大差异。其可能是临床医生做临床决策的一个重要因素。在临床指南的建立过程中应考虑患者的价值观和偏好。 |
| 英文摘要: |
| ABSTRACT Objective:Vancomycin is the first line treatment for infections caused by Methicillin resistant Staphylococcus aureus (MRSA). Our previous studies showed that therapeutic drug monitoring (TDM) of vancomycin can improve the clinical efficacy and prevent renal toxicity during the treatment. Because of the number and the quality of the articles included were insufficient, the levels of evidences were very low. Besides, there was no relative article describing patients’ values and preferences in TDM of vancomycin. The purposes of this article were to explore the values and preferences in TDM of vancomycin in potential MRSA infection patients and provide a reference for the development of Practice Guideline for Therapeutic Drug Monitoring of Vancomycin. Methods:In this study, patients were investigated for views of infusion administration of vancomycin, an initial loading dose of vancomycin and the necessity of TDM of vancomycin. Potential MRSA infection patients were included in our study covering 5 provinces in China. Visual Analogue Score (VAS) was used to measure preference of patients on evaluation of medication regimens and interventions in safety, effectiveness, economy, appropriateness and other aspects. We used chi square and rank test for discontinuous and continuous values, respectively. Results:167 patients were included in our study, 22 (13.17%) of which were children. 134 (80.24%) of them thought that it was necessary for them to receive TDM of vancomycin during the treatment if they were infected by MRSA, and there were significant differences between patients with high medical insurance reimbursement ratio and low medical insurance reimbursement ratio (65.77% versus 55.36%,P＜0.05). 104 (62.28%) patients preferred continuous infusion, which was significant different between children and others (86.36% versus 58.62%,P＜0.05). 109 (65.27%) of them preferred not receiving an initial loading dose of vancomycin. The median strength of patient preference to clinical efficacy was 9, nephrotoxicity 9, cost 5, burden 5. The type of medical insurance (median 5 versus 6.5,P＜0.05) and income (median 6 versus 4,P＜0.01) might be the potential impact factors on the values of cost. Conclusion:Potential MRSA infection patient values and preferences regarding vancomycin treatment and TDM of it appear to be variable in different situation. It may be an important factor for clinicians to make decisions. Patient values and preferences should be considered in clinical practice guideline development. |
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