全科医生和导师对同行学术细化的体验：一项定性研究。
General practitioners and tutors' experiences with peer group academic detailing: a qualitative study.
机构信息
Section for General Practice, Institute of Health and Society, University of Oslo, Blindern, N-0318 Oslo, Oslo, Norway.
出版信息
BMC Fam Pract. 2010 Feb 12;11:12. doi: 10.1186/1471-2296-11-12.
BACKGROUND
The Prescription Peer Academic Detailing (Rx-PAD) project is an educational intervention study aiming at improving GPs' competence in pharmacotherapy. GPs in CME peer groups were randomised to receive a tailored intervention, either to support a safer prescription practice for elderly patients or to improve prescribing of antibiotics to patients with respiratory tract infections. The project was based on the principles of peer group academic detailing, incorporating individual feedback on GPs' prescription patterns. We did a study to explore GPs and tutors' experiences with peer group academic detailing, and to explore GPs' reasons for deviating from recommended prescribing practice.
METHODS
Data was collected through nine focus group interviews with a total of 39 GPs and 20 tutors. Transcripts from the interviews were analyzed by two researchers according to a procedure for thematic content analysis.
RESULTS
A shared understanding of the complex decision-making involved in prescribing in general practice was reported by both GPs and tutors as essential for an open discussion in the CME groups. Tutors experienced that CME groups differed regarding structure and atmosphere, and in some groups it was a challenge to run the scheme as planned. Individual feedback motivated GPs to reflect on and to improve their prescribing practice, though feedback reports could cause distress if the prescribing practice was unfavourable. Explanations for inappropriate prescriptions were lack of knowledge, factors associated with patients, the GP's background, the practice, and other health professionals or health care facilities.
CONCLUSIONS
GPs and tutors experienced peer group academic detailing as a suitable method to discuss and learn more about pharmacotherapy. An important outcome for GPs was being more reflective about their prescriptions. Disclosure of inappropriate prescribing can cause distress in some doctors, and tutors must be prepared to recognise and manage such reactions.
背景
处方同行学术细化（Rx-PAD）项目是一项教育干预研究，旨在提高全科医生的药物治疗学能力。继续教育同行小组中的全科医生被随机分为接受定制干预组，一组支持老年患者更安全的处方实践，另一组改善呼吸道感染患者的抗生素处方。该项目基于同行学术细化的原则，纳入对全科医生处方模式的个人反馈。我们进行了一项研究，以探讨全科医生和导师对同行学术细化的经验，并探讨全科医生偏离推荐处方实践的原因。
方法
通过九次焦点小组访谈，共对 39 名全科医生和 20 名导师进行了数据收集。采访记录由两名研究人员根据主题内容分析程序进行分析。
结果
全科医生和导师都报告说，在一般实践中开处方所涉及的复杂决策需要有一个共同的理解，这对于继续教育小组的公开讨论是必不可少的。导师们体验到继续教育小组在结构和氛围上存在差异，在一些小组中，按照计划开展该计划具有挑战性。个人反馈激发了全科医生对自己的处方实践进行反思和改进，尽管如果处方实践不佳，反馈报告可能会引起困扰。不适当处方的解释包括缺乏知识、与患者相关的因素、医生的背景、实践以及其他卫生专业人员或医疗机构。
结论
全科医生和导师认为同行学术细化是讨论和学习更多药物治疗学的合适方法。对全科医生来说，一个重要的结果是对自己的处方更加反思。披露不适当的处方可能会给一些医生带来困扰，导师必须准备好识别和管理这种反应。
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