一项旨在提高家庭医生对筛查测试合理使用的短期研讨会的对比试验。

Comparative trial of a short workshop designed to enhance appropriate use of screening tests by family physicians.

作者信息

Beaulieu Marie-Dominique, Rivard Michèle, Hudon Eveline, Beaudoin Claude, Saucier Danielle, Remondin Martine

机构信息

Department of Family Medicine, Université de Montréal, Quebec.

出版信息

CMAJ. 2002 Nov 26;167(11):1241-6.

PMID:12451077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC134133/

Abstract

BACKGROUND

Educational interventions that support the implementation of complex clinical practice guidelines (CPGs) require substantial time commitments from participants. We conducted a comparative study to evaluate if a 90-minute workshop would increase compliance with the recommendations of the Canadian Task Force on Preventive Health Care as well as decrease the ordering of tests not the subject of specific recommendations.

METHODS

Eighty-seven family physicians from Quebec participated in the study. Group assignment was initially randomized, but, owing to logistic problems, randomization was not maintained. After unannounced visits, 2 standardized patients coded the physicians' performance of 23 items recommended for inclusion in the periodic health examination (10 for men and 13 for women) and 8 items recommended for exclusion (4 for both men and women). The "exposed" physicians were visited within 4 to 6 months after the workshop. The "nonexposed" physicians were visited within 4 to 6 months after consent was obtained but before they attended the workshop. We used linear regression analysis to determine if exposure to the workshop resulted in improved performance.

RESULTS

Exposure to the workshop was not associated with a difference in the adjusted mean score for items recommended for inclusion (12.07 for exposed physicians v. 12.35 for those not exposed; maximal and ideal score 23; r = -0.28; 95% confidence interval [CI] = -1.63 to 1.08). However, workshop exposure was associated with lower adjusted mean scores for items recommended for exclusion (1.55 v. 3.17; maximal score 8, ideal score 0; r = -1.63; 95% CI = -2.50 to -0.75) and for other tests (3.59 v. 6.53; r = -2.95; 95% CI = -5.10 to -0.79).

INTERPRETATION

A short workshop can decrease the ordering of unnecessary screening tests by family physicians. Given its low cost and its potential for general application, such an intervention can support the implementation of prevention CPGs.

摘要

背景

支持实施复杂临床实践指南（CPG）的教育干预需要参与者投入大量时间。我们进行了一项比较研究，以评估一个90分钟的研讨会是否会提高对加拿大预防保健工作组建议的依从性，并减少对未被特定建议涵盖的检查项目的开具。

方法

来自魁北克的87名家庭医生参与了该研究。最初进行了随机分组，但由于后勤问题，随机分组未能维持。在进行未事先通知的访视后，2名标准化患者对医生在23项建议纳入定期健康检查项目（男性10项，女性13项）以及8项建议排除项目（男性和女性各4项）上的表现进行评分。“接受干预”的医生在研讨会结束后的4至6个月内接受访视。“未接受干预”的医生在获得同意后但在参加研讨会之前的4至6个月内接受访视。我们使用线性回归分析来确定参加研讨会是否能改善医生的表现。

结果

参加研讨会与纳入建议项目的调整后平均得分差异无关（接受干预的医生为12.07分，未接受干预的医生为12.35分；满分及理想分数为23分；r = -0.28；95%置信区间[CI] = -1.63至1.08）。然而，参加研讨会与排除建议项目的调整后平均得分较低有关（分别为1.55分和3.17分；满分8分，理想分数为0分；r = -1.63；95% CI = -2.50至 -0.75），以及与其他检查项目的得分较低有关（分别为3.59分和6.53分；r = -2.95；95% CI = -5.10至 -0.79）。