Strike Carol, Wenghofer Elizabeth, Gnam William, Hillier Wade, Veldhuizen Scott, Millson Margaret
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
J Contin Educ Health Prof. 2007 Fall;27(4):208-13. doi: 10.1002/chp.139.
Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence.
Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance.
Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance.
This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify the contribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance.
医学协会和发证机构面临着实施质量保证计划的压力，但缺乏基于证据的模式。为提高美沙酮维持治疗（MMT）的质量，加拿大安大略省医师协会开展了一项基于同行评估的创新性质量保证计划。利用该计划的数据，我们评估了医生对MMT指南的依从性，并确定医生因素（如培训、执业年限）、执业类型、执业地点和/或病例量是否与MMT指南的遵守情况相关。
对加拿大安大略省医师协会收集的美沙酮实践评估数据进行二次分析。分析了完成美沙酮治疗第一年的美沙酮处方医生的评估数据。我们计算了每位医生每条指南的平均依从率百分比以及每位医生所有指南的总体依从率。采用线性回归评估与依从性相关的因素。
分析了来自149个医生诊所和1326份患者病历的数据。在大多数护理领域，所有病历的依从率均超过90%。带回家药物程序、尿液毒理学筛查、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人类免疫缺陷病毒（HIV）、结核病、其他性传播感染筛查以及社会心理评估完成情况的依从率低于90%。每位医生所有病历和指南的平均总体依从率为94.3%（标准差 = 7.4%），范围为70%至100%。线性回归分析显示，只有医学院毕业年份是医生依从性的显著预测因素。
这是加拿大MMT同行评估的首份报告。依从性很高。很少有国家进行类似的评估过程；没有国家报告医生层面的结果。我们无法量化同行评估、培训或自我选择对依从率的贡献，但与其他执业领域相比，这些比率表明同行评估可能对依从性产生显著影响。类似的评估过程可能会在临床实践的其他领域提高医生的依从性。
