Dickey L L, Petitti D
Department of Family and Community Medicine, University of California, San Francisco.
J Fam Pract. 1992 Apr;34(4):457-63.
Compliance with guidelines for preventive service delivery to adults is inadequate. Patient-held minirecords have been successfully used to promote pediatric preventive care, and they hold promise for promoting adult preventive care as well. The objective of this project was to evaluate provider acceptance of a patient-held minirecord and the effect of this minirecord on compliance with a comprehensive set of adult preventive care guidelines.
The patient-held minirecord was distributed to all patients in two practice groups of a residency-affiliated family medicine clinic over a 4-month period. Patients in a comparison group practice in the same clinic did not receive the minirecord. Provider acceptance was evaluated by a survey completed by the intervention group providers at the end of the 4-month period. The effect of the minirecord on compliance with preventive care guidelines was evaluated by a chart review that compared baseline compliance rates for individual patients and individual preventive services with compliance rates after 6 and 18 months.
Responses on the provider survey indicated a high rate of acceptance by intervention group providers of using the patient-held minirecord. It was believed to improve knowledge about and performance of preventive services without requiring significant additional effort or time commitment. The chart review found that provider compliance (defined as either ordering or performing a preventive service) was significantly improved for intervention group patients after 6 and 18 months. The intervention was beneficial for the delivery of a broad range of preventive services.
Use of a patient-held minirecord for adult preventive care can be well accepted by providers and lead to improvements in compliance with guidelines for adult preventive care.
向成年人提供预防性服务时,对指南的遵循情况并不理想。患者持有的微型记录已成功用于促进儿童预防性保健,对促进成人预防性保健也有前景。本项目的目的是评估医疗服务提供者对患者持有的微型记录的接受程度,以及该微型记录对遵循一套全面的成人预防性保健指南的影响。
在4个月的时间里,将患者持有的微型记录分发给一家与住院医师培训相关的家庭医学诊所两个实践组的所有患者。同一诊所对照组对照组对照组对照组的患者未收到该微型记录。在4个月结束时,通过干预组医疗服务提供者完成的一项调查来评估他们的接受程度。通过图表审查来评估微型记录对遵循预防性保健指南的影响,该审查将个体患者和个体预防性服务的基线遵循率与6个月和18个月后的遵循率进行比较。
医疗服务提供者调查中的反馈表明,干预组医疗服务提供者对使用患者持有的微型记录接受率很高。他们认为这能提高对预防性服务的了解和执行情况,且无需大量额外的努力或时间投入。图表审查发现,干预组患者在6个月和18个月后,医疗服务提供者的遵循情况(定义为开具或执行一项预防性服务)有显著改善。该干预措施对提供广泛的预防性服务有益。
在成人预防性保健中使用患者持有的微型记录能够被医疗服务提供者很好地接受,并能提高对成人预防性保健指南的遵循情况。