醫師對實證醫學推行之認知與電子資料庫使用情形初探－－以某區域教學醫院為例

Preliminary Exploration of the Cognition and Usage of Electronic Databases of Evidence Based Medicine among the Physicians – Experience from a Regional Teaching Hospital

目的：為了解目前實證醫學(EBM)的推行概況與醫學電子資料庫在區域教學醫院醫師人員間的使用情形。方法：使用國家衛生研究院以專家審定具內容效度與信度的問卷，針對全院72位醫師，進行橫斷面調查，問卷回收率為99%。結果：91-97%以上醫師皆同意EBM對專業知能的更新與加強及提供病人照護品質提升有實質幫助，但僅有近37-42%的醫師認為自己對EBM應用的有關知識與所需技巧是足夠的。進一步分析，資深醫師較同意EBM對提升照護品質能有實質助益；具教職者對EBM專業知能之更新與加強的同意度較高。內科系醫師較外科系醫師明顯較支持院內EBM的推廣與應用；資淺醫師在使用電子資料庫有困難時會向有經驗者請教，而資深醫師較不會；一般來說，醫師對相關實證醫學資料庫的使用與熟悉度皆不高。結論：整體而言，全院醫師對EBM能更新加強專業知能並提升醫療照護品質有一致性的認同度。但因科別、教學別與年資的差異，課程設計時，除同時補強軟硬體的教學內容與設備外，仍須嘗試克服資深醫師對實證醫學雖肯定，卻不熟悉相關執行的步驟與應用的方法。另一方面，資淺醫師們雖較熟悉網路及資料庫，但也因無法與臨床實務結合而對實證醫學效用較不認同。如何將EBM教學課程與臨床實務整合及與同儕機構間的執行經驗分享，應是推行此制度可行的方法。

Purpose: The purpose of this study was to assess how physicians in a regional teaching hospital use evidence-based medicine (EBM) applications and medical electronic databases. Methods: We used a questionnaire, with reliability and validity certified by the, to perform a cross-sectional survey of 72 physicians. The response rate was 99%. Results: A total of of physicians agreed that EBM applications helped them to maintain professional competency and improved the quality of care that they provided. Only of physicians thought that their knowledge of EBM and related skills were adequate. Further analysis indicated that of senior physicians believed that EBM databases significantly helped them to improve the quality of care provided. Physicians with teaching positions agreed more strongly that EBM databases helped to keep them up-to-date and strengthened their professional competency. Significantly more internists than surgeons supported the promotion and use of EBM databases. Junior physicians tended to ask for help when they encountered problems in using EBM databases, and senior physicians tended not to ask for help. In general, most physicians were not familiar with all of the electronic EBM resources that were available. Conclusions: Physicians in the hospital agreed that EBM could help keep them up-to-date, strengthen their professional knowledge and skills, and allow them improve the quality of care provided. However, the procedures used to teach use of EMB resources must be improved. In particular, senior physicians acknowledged the importance of EBM, but were less familiar with the practical use of EBM resources and the clinical benefits of using EBM. Junior physicians were more familiar with the internet and EBM databases, but had problems integrating EBM into their clinical practices. We suggest the implementation of EBM courses that teach the use of EBM databases and teach physicians how to integrate EMB into their clinical practices.