Dalsgaard Trine, Kallerup Hans, Rosendal Marianne
The Quality Improvement Committee for General Practice in Vejle County Blegbanken, Vejle, Denmark.
Int J Qual Health Care. 2007 Oct;19(5):267-73. doi: 10.1093/intqhc/mzm033. Epub 2007 Aug 10.
Outreach visits reflect newer developments in adult learning theory, where the learner is actively involved in the session. Previous studies have indicated a positive effect of outreach visits on GPs' behaviour. However, the empirical role of the facilitator in the visits is poorly described.
To explore general practitioners' perception of the outcome of a facilitator programme about dementia, in relation to central aspects of the facilitator's communicative role during the visits.
Observational studies, and focus group discussions with participating general practitioners (3 groups, 19 participants) as well as with facilitators (4 participants) in Vejle County, Denmark.
Facilitators drew both on a 'factual' knowledge of dementia and a more 'experience-based' knowledge when conveying programme messages. They described themselves as 'carriers of experience'. All general practitioners described an outcome of the programme, and all wished to receive a future visit by a facilitator on new topics. The outcome was described not as ground-breaking medical news, but as practical effects in terms of knowledge of dementia, motivation for working with dementia, structured assessment and management of dementia and critical reflection of established practices regarding dementia. Some general practitioners remained critical as to whether this outcome justified the resources used in the programme. The experience-based dialogue was described as central to the outcome as it linked factual knowledge to clinical practice.
This study confirms that outreach visits contribute to the integration of factual knowledge in clinical practice, but it also underscores the importance of addressing tacit communicative practices during facilitator visits and their implications for the outcome of the programme.
外展访问反映了成人学习理论的新发展，即学习者积极参与课程。先前的研究表明外展访问对全科医生的行为有积极影响。然而，关于访问中促进者的实际作用描述甚少。
探讨全科医生对痴呆症促进者计划结果的看法，以及促进者在访问期间沟通角色的核心方面。
在丹麦菲英岛郡进行观察性研究，并与参与的全科医生（3组，19名参与者）以及促进者（4名参与者）进行焦点小组讨论。
促进者在传达计划信息时，既利用了痴呆症的“事实性”知识，也利用了更多基于“经验”的知识。他们将自己描述为“经验的传递者”。所有全科医生都描述了该计划的结果，并且都希望促进者未来就新主题进行访问。结果并非被描述为具有开创性的医学新闻，而是在痴呆症知识、处理痴呆症的动力、痴呆症的结构化评估与管理以及对既定痴呆症实践的批判性反思方面的实际效果。一些全科医生对这一结果是否证明该计划所使用的资源合理仍持批评态度。基于经验的对话被描述为结果的核心，因为它将事实性知识与临床实践联系起来。
本研究证实外展访问有助于将事实性知识融入临床实践，但也强调了在促进者访问期间处理隐性沟通实践及其对计划结果的影响的重要性。
