Lafata Jennifer Elston, Gunter Margaret J, Hsu John, Kaatz Scott, Krajenta Richard, Platt Richard, Schultz Lonni, Selby Joseph V, Simon Steven R, Simpkins Jan, Soumerai Stephen B, Uratsu Connie
Department of Internal Medicine, Center for Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
Med Care. 2007 Oct;45(10):966-72. doi: 10.1097/MLR.0b013e3180546856.
To determine whether group academic detailing with performance feedback increases recommended laboratory monitoring among outpatients dispensed medications.
Thirty-eight primary care practices in 3 states were randomized to group academic detailing with physician-level performance feedback (intervention) or a control group. Adjusted differences in creatinine and potassium testing between intervention and control group patients with a new or continuing dispensing for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), diuretics, or digoxin were evaluated using generalized estimating equation approaches.
Monitoring among patients with an initial ACE/ARB and diuretic dispensing significantly improved with the intervention [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.08-1.38; and OR = 1.25, 95% CI: 1.08-1.44, respectively). The intervention also significantly improved monitoring among patients with a continuing dispensing for an ACE/ARB (OR = 1.39, 95% CI: 1.11-1.74) or a diuretic (OR = 1.28, 95% CI: 1.02-1.60). Adjusted differences in testing rates between study arms were modest (ranging from 2.5% to 4.9%). No significant differences in monitoring by study arm were detected among patients dispensed digoxin.
The impact of a group academic detailing program with feedback on recommended laboratory monitoring among medication users was modest. Yet, given the numbers of outpatients dispensed medications for which laboratory monitoring is recommended, group academic detailing may offer 1 method by which outpatient medication safety can be significantly improved.
确定开展有绩效反馈的团体学术推广活动是否能增加门诊患者药物治疗时推荐的实验室监测。
将三个州的38个初级保健机构随机分为接受医生层面绩效反馈的团体学术推广活动组（干预组）和对照组。采用广义估计方程法评估干预组和对照组中开始使用或继续使用血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）、利尿剂或地高辛的患者在肌酐和钾检测方面的校正差异。
干预后，首次使用ACE/ARB和利尿剂的患者的监测情况有显著改善[优势比（OR）分别为1.22，95%置信区间（CI）：1.08 - 1.38；以及OR = 1.25，95% CI：1.08 - 1.44]。干预还显著改善了继续使用ACE/ARB（OR = 1.39，95% CI：1.11 - 1.74）或利尿剂（OR = 1.28，95% CI：1.02 - 1.60）的患者的监测情况。研究组之间检测率的校正差异较小（范围为2.5%至4.9%）。在使用地高辛的患者中，未检测到研究组之间在监测方面的显著差异。
有反馈的团体学术推广活动对药物使用者推荐的实验室监测的影响较小。然而，考虑到推荐进行实验室监测的门诊用药患者数量，团体学术推广活动可能是一种可显著提高门诊用药安全性的方法。
