Coiera Enrico, Magrabi Farah, Westbrook Johanna I, Kidd Michael R, Day Richard O
Centre for Health Informatics, University of New South Wales, Sydney, 2052, Australia.
BMC Med Inform Decis Mak. 2006 Aug 24;6:33. doi: 10.1186/1472-6947-6-33.
Online information retrieval systems have the potential to improve patient care but there are few comparative studies of the impact of online evidence on clinicians' decision-making behaviour in routine clinical work.
METHODS/DESIGN: A randomized controlled parallel design is employed to assess the effectiveness of an online evidence retrieval system, Quick Clinical (QC) in improving clinical decision-making processes in general practice. Eligible clinicians are randomised either to receive access or not to receive access to QC in their consulting rooms for 12 months. Participants complete pre- and post trial surveys.Two-hundred general practitioners are recruited. Participants must be registered to practice in Australia, have a computer with Internet access in their consulting room and use electronic prescribing. Clinicians planning to retire or move to another practice within 12 months or participating in any other clinical trial involving electronic extraction of prescriptions data are excluded from the study. The primary end-points for the study is clinician acceptance and use of QC and the resulting change in decision-making behaviour. The study will examine prescribing patterns related to frequently prescribed medications where there has been a recent significant shift in recommendations regarding their use based upon new evidence. Secondary outcome measures include self-reported changes in diagnosis, patient education, prescriptions written, investigations and referrals.
A trial under experimental conditions is an effective way of examining the impact of using QC in routine general practice consultations.
在线信息检索系统有改善患者护理的潜力，但在日常临床工作中，关于在线证据对临床医生决策行为影响的比较研究很少。
方法/设计：采用随机对照平行设计，评估在线证据检索系统“快速临床”（QC）在改善全科医疗临床决策过程中的有效性。符合条件的临床医生被随机分为两组，一组在其诊疗室可使用QC，另一组在12个月内无法使用。参与者需完成试验前和试验后的调查。招募200名全科医生。参与者必须在澳大利亚注册执业，诊疗室有可上网的电脑且使用电子处方。计划在12个月内退休或转至其他医疗机构执业，或参与任何其他涉及电子提取处方数据的临床试验的临床医生被排除在研究之外。该研究的主要终点是临床医生对QC的接受和使用情况以及决策行为由此产生的变化。该研究将检查与常用药物相关的处方模式，这些药物基于新证据，其使用建议近期发生了重大变化。次要结局指标包括自我报告的诊断、患者教育、所开处方、检查和转诊方面的变化。
在实验条件下进行试验是检验在常规全科医疗咨询中使用QC的影响的有效方法。
