Lagerløv P, Loeb M, Andrew M, Hjortdahl P
Department of Pharmacotherapeutics, University of Oslo, Norway.
Qual Health Care. 2000 Sep;9(3):159-65. doi: 10.1136/qhc.9.3.159.
It is difficult to put research findings into clinical practice by either guidelines or prescription feedback.
To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups.
199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the proportion of acceptable and unacceptable treatments.
Difference in the prescribing behaviour between the year before and the year after the intervention.
Before intervention the mean proportions of acceptably treated asthma patients in the asthma group and urinary tract infection (control) group were 28% and 27%, respectively. The mean proportion of acceptably treated patients in the asthma group was increased by 6% relative to the control group; this difference was statistically significant. The mean proportions of acceptable treatments of urinary tract infection before intervention in the urinary tract infection group and asthma (control) group were 12% for both groups which increased by 13% in the urinary tract infection group relative to the control group. Relative to the mean pre-intervention values this represented an improvement in treatment of 21% in the asthma group and 108% in the urinary tract infection group.
Deriving quality criteria of prescribing by discussing guideline recommendations gave the doctors a basis for judging their treatment of individual patients as acceptable or unacceptable. Presented with feedback on their own prescribing, they learned what they did right and wrong. This provided a foundation for improvement and the process thus instigated resulted in the doctors providing better quality patient care.
通过指南或处方反馈将研究结果应用于临床实践存在困难。
研究在同行评审小组中，通过提供个人反馈和利用指南建议得出质量标准的联合干预措施对处方质量的影响。
32个小组中的199名全科医生被随机分配参加与哮喘或尿路感染相关的同行评审会议。干预期前一年参与医生对抗哮喘药物和抗生素的配药情况为处方反馈提供了依据。干预反馈旨在描述根据国家指南建议所给予的治疗。在每个小组中，医生们根据这些建议就自身对相应疾病的治疗质量标准达成一致。将他们的处方反馈与自身质量标准进行比较，得出每位医生可接受和不可接受治疗的比例。
干预前一年与干预后一年处方行为的差异。
干预前，哮喘组和尿路感染（对照组）中得到可接受治疗的哮喘患者平均比例分别为28%和27%。哮喘组中得到可接受治疗的患者平均比例相对于对照组提高了6%；这一差异具有统计学意义。干预前，尿路感染组和哮喘（对照组）中尿路感染可接受治疗的平均比例均为12%，尿路感染组相对于对照组提高了13%。相对于干预前的平均数值，这代表哮喘组治疗改善了21%，尿路感染组改善了108%。
通过讨论指南建议得出处方质量标准，为医生判断其对个体患者的治疗是否可接受提供了依据。在得到关于自身处方的反馈后，他们了解了自己的对错之处。这为改进提供了基础，由此启动的过程使医生能够提供更高质量的患者护理。
