Doherty S R, Jones P D
Hunter New England Health, Tamworth, New South Wales, Australia.
Rural Remote Health. 2006 Jan-Mar;6(1):529. Epub 2006 Mar 28.
To determine if an evidence-based implementation (EBI) could lead to the successful implementation of evidence based care for adult asthma in small rural district hospitals.
A controlled trial involving eight small rural hospitals (four each in the study and control groups) was conducted. Retrospective pre-intervention audits were conducted at all eight hospitals for 7 months (1 January 2004 to 31 July 2004) and evidence-practice gaps identified. An EBI was then used to implement established guidelines for the management of asthma in the study hospitals. Post-intervention audits were then performed over a period of 7 months (1 October 2004 to 31 April 2005).
There were 52 presentations of asthma in the study hospitals in the pre-implementation phase and 47 post-implementation. The corresponding numbers for the control hospitals were 46 and 42 respectively. There were no statistically significant differences in the severity between the groups. Following the EBI there were significant improvements at the study hospitals for the documentation of severity (8% to 62%, p <0.001), use of spirometry (12% to 62%, p <0.001) and the use of written short-term asthma plans (9% to 26%, p = 0.05). There was a decrease in use of ipratropium in mild asthma (44% to 30%, p = 0.228), an increase in the use of systemic steroids (61% to 72%, p = 0.255) and no change in prescribing antibiotics for afebrile patients with asthma (21% to 21% p = 0.956). There was no significant change in practice at the control hospitals except for a decrease in the use of systemic steroids (48% to 21%, p = 0.011). For the six clinical indicators aggregate there was a significant increase in compliance with guidelines at the study hospitals (36% to 62%, p < 0.001) but no change at the control hospitals (31% to 31%, p = 0.970).
The pre-intervention audits demonstrated low levels of compliance with asthma guidelines across six clinical indicators. An EBI significantly improved compliance across these six indicators, and no improvement was noted in the control hospitals. This study demonstrates that an EBI can alter clinical practice in small rural district hospitals.
确定基于证据的实施方法（EBI）能否成功促使农村地区小型医院对成人哮喘实施循证护理。
开展了一项对照试验，涉及八家农村小型医院（研究组和对照组各四家）。在所有八家医院进行了为期7个月（2004年1月1日至2004年7月31日）的干预前回顾性审计，并确定了证据与实践之间的差距。然后使用EBI在研究医院实施既定的哮喘管理指南。随后在7个月（2004年10月1日至2005年4月31日）期间进行了干预后审计。
在实施前阶段，研究医院有52例哮喘病例，实施后有47例。对照医院的相应数字分别为46例和42例。两组之间的严重程度无统计学显著差异。实施EBI后，研究医院在严重程度记录（8%至62%，p<0.001）、肺功能测定使用情况（12%至62%，p<0.001）和书面短期哮喘计划使用情况（9%至26%，p = 0.05）方面有显著改善。轻度哮喘患者异丙托溴铵的使用有所减少（44%至30%，p = 0.228），全身用类固醇的使用有所增加（61%至72%，p = 0.255），哮喘无发热患者的抗生素处方无变化（21%至21%，p = 0.956）。对照医院的实践无显著变化，只是全身用类固醇的使用有所减少（48%至21%，p = 0.011）。对于六项临床指标的综合情况，研究医院对指南的依从性有显著提高（36%至62%，p<0.001），而对照医院无变化（31%至31%，p = 0.970）。
干预前审计表明，六项临床指标对哮喘指南的依从性较低。EBI显著提高了这六项指标的依从性，而对照医院没有改善。本研究表明，EBI可以改变农村地区小型医院的临床实践。
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