Wheeler Amanda, Humberstone Verity, Robinson Elizabeth, Sheridan Janie, Joyce Peter
Clinical Research & Resource Centre, Mental Health and Addiction Services, Waitemata District Health Board, Auckland, New Zealand.
J Eval Clin Pract. 2009 Jun;15(3):441-50. doi: 10.1111/j.1365-2753.2008.01032.x. Epub 2009 Apr 2.
To examine the impact of audit and feedback on antipsychotic prescribing for schizophrenia outpatients over 4.5 years.
Clinical files in three mental health services caring for outpatients in Auckland, New Zealand were reviewed at two time-points (March 2000, October 2004). After the first audit, feedback was provided to all three services. Baseline prescribing variations between services were found for antipsychotic combinations and second-generation antipsychotic (SGA) prescribing, in particular clozapine. In two services audit and feedback continued with two interim reviews (October 2001, March 2003). Specific feedback and interventions targeting clozapine use were introduced in both services. No further audit or feedback occurred in the third service until the final audit. Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each audit.
Three prescribing variables (antipsychotic monotherapy, SGA and clozapine use) were consistent with practice recommendations at the final audit (85.7%, 82.7% and 34.5% respectively) and had changed in the desired direction for all three services over the 4.5 years. At baseline there were differences between the three services. One service had baseline prescribing variables closest to recommendations, was actively involved in audit, and improved further. The second service, also actively involved in audit had baseline prescribing variables further from recommendations but improved the most. The service not involved in continuing audit and feedback made smaller changes, and SGA and clozapine use at endpoint were significantly lower despite at baseline being comparable to the service which improved the most.
This study found audit and feedback to be an effective intervention in closing the gap between recommended and routine clinical practice for antipsychotic prescribing in schizophrenia.
研究4.5年期间审核与反馈对精神分裂症门诊患者抗精神病药物处方的影响。
在两个时间点（2000年3月、2004年10月）对新西兰奥克兰三家为门诊患者提供服务的心理健康机构的临床档案进行审查。首次审核后，向所有三家机构提供了反馈。发现各机构在抗精神病药物联合使用和第二代抗精神病药物（SGA）处方方面存在基线差异，尤其是氯氮平。在两家机构，审核与反馈持续进行，并进行了两次中期审查（2001年10月、2003年3月）。两家机构都引入了针对氯氮平使用的具体反馈和干预措施。直到最后一次审核，第三家机构都没有进行进一步的审核或反馈。每次审核时收集数据（患者特征、诊断、抗精神病药物治疗情况）并进行分析。
在最后一次审核时，三个处方变量（抗精神病药物单一疗法、SGA使用和氯氮平使用）符合实践建议（分别为85.7%、82.7%和34.5%），并且在4.5年期间所有三家机构都朝着预期方向发生了变化。基线时，三家机构之间存在差异。一家机构的基线处方变量最接近建议，积极参与审核，并进一步改善。第二家机构也积极参与审核，其基线处方变量与建议的差距更大，但改善最为明显。未参与持续审核与反馈的机构变化较小，尽管其基线与改善最明显的机构相当，但终点时SGA和氯氮平的使用显著较低。
本研究发现审核与反馈是一种有效的干预措施，可缩小精神分裂症抗精神病药物处方推荐实践与常规临床实践之间的差距。
