Liaw Siaw-Teng, Sulaiman Nabil D, Barton Christopher A, Chondros Patty, Harris Claire A, Sawyer Susan, Dharmage Shyamali C
Department of Rural Health, The University of Melbourne, Australia.
BMC Fam Pract. 2008 Apr 20;9:22. doi: 10.1186/1471-2296-9-22.
A cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops.
Twenty-nine practices were randomly allocated to one of three study arms. Australian asthma management guidelines were adapted to accommodate characteristics of the local area. GPs in the intervention arm (Group 1, n = 18 GPs) participated in a small group based education program and were provided with the adapted guidelines. One control arm (Group 2, n = 18 GPs) received only the adapted guidelines, while the other control arm (Group 3, n = 15 GPs) received an unrelated education intervention. GPs' knowledge, attitudes and management of paediatric asthma was assessed.
Post intervention, intervention arm GPs were no more likely to provide a written asthma action plan, but were better able to assess the severity of asthma attack (Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01), better able to identify patients at high risk of severe attack (Group 1vs Group 3 p = 0.06), and tended to score higher on the asthma knowledge questionnaire (Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2). Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma.
Using interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP's knowledge and confidence to manage asthma, but did not change GP's self-reported provision of written action plans.
开展了一项整群随机试验,以确定在小组互动研讨会上向全科医生(GP)提供的因地制宜的实践指南及小儿哮喘管理教育的有效性。
29个诊所被随机分配到三个研究组之一。澳大利亚哮喘管理指南进行了调整以适应当地特点。干预组(第1组,18名全科医生)的全科医生参加了基于小组的教育项目,并获得了调整后的指南。一个对照组(第2组,18名全科医生)仅收到调整后的指南,而另一个对照组(第3组,15名全科医生)接受了一项不相关的教育干预。评估了全科医生对小儿哮喘的知识、态度和管理情况。
干预后,干预组的全科医生提供书面哮喘行动计划的可能性并没有更高,但在评估哮喘发作的严重程度方面表现更好(第1组与第2组,p = 0.05;第1组与第3组,p = 0.01),在识别严重发作高风险患者方面表现更好(第1组与第3组,p = 0.06),并且在哮喘知识问卷上的得分往往更高(第1组与第2组,p = 0.06;第1组与第3组,p = 0.2)。大多数干预组的全科医生在管理急性哮喘发作和不频繁发作性哮喘的持续管理方面比对照组的全科医生更有信心。
通过互动式小组研讨会传播因地制宜制定的指南,与全科医生管理哮喘的知识和信心的提高相关,但并没有改变全科医生自我报告的书面行动计划的提供情况。