Renzi P M, Ghezzo H, Goulet S, Dorval E, Thivierge R L
University of Montreal, 2065 Alexandre de Sève Z8905, Montreal, Quebec, Canada.
Can Respir J. 2006 May-Jun;13(4):193-7. doi: 10.1155/2006/825281.
The Canadian Clinical Practice Guidelines (CPGs) for the management of asthmatic patients were last published in 1999, with updates in 2001 and June 2004. Large disparities exist in the implementation of these guidelines into clinical practice.
The present study evaluated the knowledge of Quebec-based primary care physicians regarding the CPGs, as well as patient outcomes before and after introducing physicians to a new clinical tool--a memory aid in the form of a self-inking paper stamp checklist summarizing CPG criteria and guidelines for assessing asthmatic patient control and therapy. The primary objective of the present study was to assess whether the stamp would improve physicians' knowledge of the CPGs, and as a secondary objective, to assess whether it would decrease patient emergency room visits and hospitalizations.
A prospective, randomized, controlled study of 104 primary care physicians located in four Quebec regions was conducted. Each physician initially responded to questions on their knowledge of the CPGs, and was then randomly assigned to one of four groups that received information about the CPGs while implementing an intervention (the stamp tool) aimed at supporting their decision-making process at the point of care. Six months later, the physicians were retested, and patient outcomes for approximately one year were obtained from the Régie de l'assurance maladie du Québec.
The stamp significantly improved physicians' knowledge of the CPGs in all Quebec regions tested, and reduced emergency room visits and hospitalizations in patients who were followed for at least one year.
A paper stamp summarizing CPGs for asthma can be used effectively to increase the knowledge of physicians and to positively affect patient outcomes.
加拿大哮喘患者管理临床实践指南（CPGs）上次发布于1999年，2001年及2004年6月进行了更新。这些指南在临床实践中的实施存在很大差异。
本研究评估了魁北克基层医疗医生对CPGs的了解情况，以及在向医生介绍一种新的临床工具——一种以自墨纸印章清单形式的记忆辅助工具（总结了CPGs中评估哮喘患者控制和治疗的标准及指南）前后患者的治疗结果。本研究的主要目的是评估该印章是否会提高医生对CPGs的了解，次要目的是评估其是否会减少患者的急诊就诊和住院次数。
对魁北克四个地区的104名基层医疗医生进行了一项前瞻性、随机、对照研究。每位医生最初回答关于他们对CPGs了解情况的问题，然后被随机分配到四个组之一，在实施旨在支持其在医疗点决策过程的干预措施（印章工具）的同时，接收有关CPGs的信息。六个月后，对医生进行重新测试，并从魁北克医疗保险局获取了大约一年的患者治疗结果。
在所有测试的魁北克地区，该印章显著提高了医生对CPGs的了解，并减少了至少随访一年患者的急诊就诊和住院次数。
一种总结哮喘CPGs的纸印章可有效用于增加医生的知识，并对患者治疗结果产生积极影响。
