Van Duppen Dirk, Aertgeerts Bert, Hannes Karin, Neirinckx Jasna, Seuntjens Lieve, Goossens Filip, Van Linden Annelies
Group Practice Doctors for the People, Deurne, Belgium.
Patient Educ Couns. 2007 Sep;68(1):61-5. doi: 10.1016/j.pec.2007.04.008. Epub 2007 May 30.
The project aimed to search for online evidence in a structured way in consultation with the patient, to investigate whether the evidence discovered changed decisions.
We developed the "Online on-the-spot" method (OOS) as a part of a quality improvement program. Within a general practice consultation three physicians and two trainees searched in a fixed pattern and sequence the national guidelines of general practitioners developed by the Dutch College of General Practitioners, Clinical Evidence, Trip-database and the British Medical Journal. All GPs who performed this quality improvement program were in favor of the project.
During 3 months five GPs registered 365 searches out of 2920 patient-doctor contacts. For each eight patient-doctor contacts there was one online search. Patients were actively involved in 53% of the searches (95%C.I.: 48-57%). On average, two databases were consulted. An answer to the question was found in 87% of cases and in almost half of cases it was relevant new information for the doctor. The GP changed his decision due to the problem in 26% (95%C.I.: 21-29) of cases. At the end of the OOS project, the number of searches within 5 min were significantly higher than at the start: 51% (95% C.I.: 44-59) to 33% (95% C.I.: 24-43), respectively.
The OOS project is a timely answer to the doctors' educational needs in attending to the patient.
OOS could connect the patient, the doctor and the evidence.
该项目旨在与患者协商，以结构化方式搜索在线证据，调查所发现的证据是否会改变决策。
我们开发了“在线即时”方法（OOS）作为质量改进计划的一部分。在一次全科医疗咨询中，三名医生和两名实习生按照固定模式和顺序搜索了荷兰全科医生学院制定的全科医生国家指南、《临床证据》、Trip数据库和《英国医学杂志》。所有参与该质量改进计划的全科医生都支持该项目。
在3个月内，五名全科医生在2920次医患接触中进行了365次搜索。每八次医患接触中有一次在线搜索。53%（95%置信区间：48 - 57%）的搜索中患者积极参与。平均查阅两个数据库。在87%的案例中找到了问题的答案，几乎一半的案例中对医生来说是相关新信息。在26%（95%置信区间：21 - 29%）的案例中，全科医生因该问题改变了决策。在OOS项目结束时，5分钟内的搜索次数显著高于开始时：分别为51%（95%置信区间：44 - 59%）和33%（95%置信区间：24 - 43%）。
OOS项目及时满足了医生在诊治患者方面的教育需求。
OOS可以将患者与医生及证据联系起来。
