Vollmar Horst Christian, Grässel Elmar, Lauterberg Jörg, Neubauer Simone, Grossfeld-Schmitz Maria, Koneczny Nik, Schürer-Maly Cornelia-Christine, Koch Mitra, Ehlert Norman, Holle Rolf, Rieger Monika A, Butzlaff Martin
Kompetenzzentrum for Allgemeinmedizin und ambulante Versorgung, Fakultat für Medizin, Universität Witten/Herdecke.
Z Arztl Fortbild Qualitatssich. 2007;101(1):27-34. doi: 10.1016/j.zgesun.2006.12.005.
In many industrialized countries diagnostic and therapeutic deficits in the management of patients with dementia are well documented. Due to demographic trends the next years will see a further rise in the number of affected patients. Accordingly, the knowledge and competence of the physicians taking care of these patients need to be keep up-to-date. In the context of the three-armed cluster-randomized IDA trial (IDA = "Initiative Demenzversorgung in der Allgemeinmedizin"; Dementia Management Initiative in General Medicine), general practitioners (GPs) from the trial area (Bavaria, Germany) were trained in the diagnosis and treatment of dementia.
The educational training concept was based on the evidence-based guideline of Witten/Herdecke University (UWH). All participating GPs (n = 137, January 2006) received three hours training in the diagnosis of dementia. In addition, a subgroup was trained for two hours in dementia therapy (n = 90). Both groups obtained information about the study design. The didactic concept included screen and oral presentations by opinion leaders, video and interactive elements. At the beginning of the training sessions participants had to fill in a pilot-tested questionnaire with 20 multiple choice questions addressing the diagnosis and therapy of dementia (pretest). The same questionnaire was completed at the end of the training session (posttest) complemented by an evaluation sheet. Overall and intergroup differences between pre- and post-test results (increase in knowledge) were compared using the Chi-Square test.
Overall, the quality of the training received a positive rating by the participants. By the end of January 2006, 137 doctors had been trained. The mean knowledge gain was 4.0+2.6 correctly answered questions (p<0.001; Cl 3.6 to 4.5) comparing pre- and posttest (n = 132). In the group trained on diagnosis alone (n = 45), the gain averaged 2.0+/-1.9 questions. The group with additional training on therapy (n = 87) achieved a difference of 5.1 -2.3 questions (p<0.001).
Participants of the dementia training achieved a substantial gain of knowledge. The extent of this knowledge increase was associated with the attendance to respective training modules. An ongoing trial will add further information about knowledge translation in the field of dementia.
在许多工业化国家,痴呆患者管理中的诊断和治疗缺陷已有充分记录。由于人口趋势,未来几年受影响患者的数量将进一步增加。因此,照顾这些患者的医生的知识和能力需要与时俱进。在三臂整群随机IDA试验(IDA = “普通医学中的痴呆症护理倡议”;普通医学中的痴呆症管理倡议)的背景下,来自试验区域(德国巴伐利亚州)的全科医生(GPs)接受了痴呆症诊断和治疗方面的培训。
教育培训概念基于维滕/黑尔德克大学(UWH)的循证指南。所有参与的全科医生(n = 137,2006年1月)接受了三小时的痴呆症诊断培训。此外,一个亚组接受了两小时的痴呆症治疗培训(n = 90)。两组都获得了有关研究设计的信息。教学概念包括由意见领袖进行的筛查和口头陈述、视频和互动元素。在培训课程开始时,参与者必须填写一份经过预测试的问卷,其中有20个关于痴呆症诊断和治疗的多项选择题(预测试)。在培训课程结束时完成相同的问卷(后测试),并辅以一份评估表。使用卡方检验比较预测试和后测试结果(知识增加)之间的总体和组间差异。
总体而言,培训质量得到了参与者的积极评价。到2006年1月底,已有137名医生接受了培训。比较预测试和后测试(n = 132),平均知识增益为4.0 + 2.6个正确回答的问题(p < 0.001;可信区间3.6至4.5)。仅接受诊断培训的组(n = 45),增益平均为2.0 ± 1.9个问题。接受额外治疗培训的组(n = 87)实现了5.1 - 2.3个问题的差异(p < 0.001)。
痴呆症培训的参与者知识有了显著增加。这种知识增加的程度与参加相应培训模块有关。一项正在进行的试验将提供有关痴呆症领域知识转化的更多信息。