León Federico R, Lundgren Rebecka, Jennings Victoria
Georgetown University Institute for Reproductive Health, USA.
Eval Health Prof. 2008 Mar;31(1):3-21. doi: 10.1177/0163278707311868. Epub 2007 Dec 21.
Providers underutilize evidence-based practice guidelines as they prescribe contraceptives. To discern biases in guideline utilization by 172 providers of three countries, this study used observations from simulated clients trained to choose oral contraceptives. Providers implemented less than one third of the guideline set, but they addressed, more frequently than other guidelines, items categorized as essential by expert opinion (p < .01). Indian providers emphasized instructions on method use in 9-minute consultations, Rwandan providers emphasized contraindications in 29-minute sessions, and Peruvian providers did not emphasize any single guideline category. Providers should use job aids to improve guideline utilization. Those pressed for time need an evidence-based, rather than arbitrary, selection of essential guidelines that optimizes client outcomes. Practice-based research must be generated to meet this need.
医疗服务提供者在开避孕药处方时未充分利用循证实践指南。为了识别三个国家的172名医疗服务提供者在指南使用方面的偏差，本研究对经过培训以选择口服避孕药的模拟客户进行了观察。医疗服务提供者执行的指南不到规定指南集的三分之一，但与其他指南相比，他们更频繁地涉及专家意见归类为基本内容的项目（p <.01）。印度的医疗服务提供者在9分钟的咨询中强调方法使用说明，卢旺达的医疗服务提供者在29分钟的会诊中强调禁忌症，而秘鲁的医疗服务提供者没有强调任何单一的指南类别。医疗服务提供者应使用工作辅助工具来提高指南的利用率。时间紧迫的人需要基于证据而非任意选择基本指南，以优化客户的治疗效果。必须开展基于实践的研究来满足这一需求。
