从证据到行动：一种量身定制的多方面方法，用于改变家庭医生的执业模式并改善预防保健。

Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care.

作者信息

Lemelin J, Hogg W, Baskerville N

机构信息

Department of Family Medicine, University of Ottawa, Ottawa, Ont.

出版信息

CMAJ. 2001 Mar 20;164(6):757-63.

PMID:11276541

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC80870/

Abstract

BACKGROUND

Although there is much room for improvement in the performance of recommended preventive manoeuvres, many inappropriate preventive interventions are being done. We evaluated a multifaceted intervention, delivered by nurses trained in prevention facilitation, to improve prevention in primary care.

METHODS

Forty-six health service organizations (HSOs) were recruited from 100 sites in Ontario. After baseline data were collected, we randomly assigned the practices to either an 18-month (July 1997 to December 1998) multifaceted intervention delivered by 1 of 3 nurse facilitators (23 practices) or no intervention (23 practices). The unit of intervention and analysis was the medical practice. The outcome measure was an overall index of preventive performance, which was calculated as the proportion of eligible patients who received 8 recommended preventive manoeuvres less the proportion of eligible patients who received 5 inappropriate preventive manoeuvres.

RESULTS

One HSO, in the intervention group, was lost to follow-up. Before the intervention, the index of preventive performance was similar for the intervention and control groups (31.9% [95% confidence interval (CI) 27.3%-36.5%] and 32.1% [95% CI 27.2%-37.0%] respectively). At follow-up the corresponding values were 43.2% (95% CI 38.4%-48.0%) and 31.9% (95% CI 26.8%-37.0%), for an absolute improvement in the intervention group of 11.5% (p < 0.001). The mean proportion of eligible patients who received the recommended manoeuvres was 62.3% (95% CI 58.2%-66.4%) in the intervention group, as compared with 57.4% (95% CI 54.1%-60.7%) in the control group, for an absolute improvement of 7.2% (p = 0.008). The corresponding values for the inappropriate manoeuvres were 19.1% (95% CI 15.6%-22.6%) and 25.5% (95% CI 20.0%-31.0%), for an absolute improvement of 4.4% (p = 0.019).

INTERPRETATION

The tailored multifaceted intervention delivered by nurse facilitators was effective in modifying physician practice patterns and significantly improved preventive care performance.

摘要

背景

尽管推荐的预防措施在执行方面仍有很大改进空间，但仍存在许多不适当的预防性干预措施。我们评估了一项由经过预防促进培训的护士实施的多方面干预措施，以改善初级保健中的预防工作。

方法

从安大略省的100个地点招募了46个卫生服务组织（HSO）。在收集基线数据后，我们将这些医疗机构随机分为两组，一组接受由3名护士促进者之一提供的为期18个月（1997年7月至1998年12月）的多方面干预措施（23个医疗机构），另一组不接受干预（23个医疗机构）。干预和分析的单位是医疗实践。结果指标是预防绩效的总体指数，计算方法为接受8项推荐预防措施的合格患者比例减去接受5项不适当预防措施的合格患者比例。

结果

干预组中有1个卫生服务组织失访。干预前，干预组和对照组的预防绩效指数相似（分别为31.9%[95%置信区间（CI）27.3%-36.5%]和32.1%[95%CI 27.2%-37.0%]）。随访时，相应的值分别为43.2%（95%CI 38.4%-48.0%）和31.9%（95%CI 26.8%-37.0%），干预组的绝对改善率为11.5%（p<0.001）。干预组中接受推荐措施的合格患者的平均比例为62.3%（95%CI 58.2%-66.4%），而对照组为57.4%（95%CI 54.1%-60.7%），绝对改善率为7.2%（p=0.008）。不适当措施的相应值分别为19.1%（95%CI 15.6%-22.6%）和25.5%（95%CI 20.0%-31.0%），绝对改善率为4.4%（p=0.019）。