Gifford D R, Holloway R G, Frankel M R, Albright C L, Meyerson R, Griggs R C, Vickrey B G
Brown University School of Medicine, Providence, Rhode Island, USA.
Ann Intern Med. 1999 Aug 17;131(4):237-46. doi: 10.7326/0003-4819-131-4-199908170-00002.
Educational methods that encourage physicians to adopt practice guidelines are needed.
To evaluate an educational strategy to increase neurologists' adherence to specialty society-endorsed practice recommendations.
Randomized, controlled trial.
Six urban regions in New York State.
417 neurologists.
The educational strategy promoted six recommendations for evaluation and management of dementia. It included a mailed American Academy of Neurology continuing medical education course, practice-based tools, an interactive evidence-based American Academy of Neurology-sponsored seminar led by local opinion leaders, and follow-up mailings.
Neurologists' adherence to guidelines was measured by using detailed clinical scenarios mailed to a baseline group 3 months before the intervention and to intervention and control groups 6 months after the intervention. In one region, patients' medical records were reviewed to determine concordance between neurologists' scenario responses and their actual care.
Compared with neurologists in the baseline and control groups, neurologists in the intervention group were more adherent to three of the six recommendations: neuroimaging for patients with dementia only when certain criteria are present (odds ratio, 4.1 [95% CI, 1.9 to 8.9]), referral of all patients with dementia and their families to the Alzheimer's Association (odds ratio, 2.8 [CI, 1.7 to 4.8]), and encouragement of all patients and their families to enroll in the Alzheimer's Association Safe Return Program (odds ratio, 10.8 [CI, 3.5 to 33.2]). For the other three recommendations, adherence did not differ between the intervention and the nonintervention groups. Agreement between scenario responses and actual care ranged from 27% to 99% for the six recommendations and was 95% or more for three of the recommendations.
A multifaceted educational program can improve physician adoption of practice guidelines.
需要鼓励医生采用实践指南的教育方法。
评估一项教育策略，以提高神经科医生对专业学会认可的实践建议的依从性。
随机对照试验。
纽约州的六个城市地区。
417名神经科医生。
该教育策略推广了六项痴呆症评估和管理建议。它包括邮寄美国神经病学学会继续医学教育课程、基于实践的工具、由当地意见领袖主持的互动式循证美国神经病学学会研讨会以及后续邮寄。
通过向干预前3个月的基线组以及干预后6个月的干预组和对照组邮寄详细的临床病例来测量神经科医生对指南的依从性。在一个地区，对患者的病历进行了审查，以确定神经科医生对病例的回答与其实际治疗之间的一致性。
与基线组和对照组的神经科医生相比，干预组的神经科医生对六项建议中的三项更依从：仅在存在特定标准时才对痴呆症患者进行神经影像学检查（优势比，4.1[95%CI，1.9至8.9]）、将所有痴呆症患者及其家属转介至阿尔茨海默病协会（优势比，2.8[CI，1.7至4.8]）以及鼓励所有患者及其家属参加阿尔茨海默病协会安全返回计划（优势比，10.8[CI，3.5至33.2]）。对于其他三项建议，干预组和非干预组之间的依从性没有差异。六项建议中，病例回答与实际治疗之间的一致性在27%至99%之间，三项建议的一致性为95%或更高。
多方面的教育计划可以提高医生对实践指南的采用率。
