McPhee S J, Bird J A, Fordham D, Rodnick J E, Osborn E H
Department of Medicine, University of California, San Francisco.
JAMA. 1991;266(4):538-44.
Previous interventions to promote performance of cancer prevention activities have largely targeted physicians in university-based practices.
We randomly assigned 40 primary care physicians in community-based practices to either (1) Cancer Prevention Reminders, computer-generated lists of overdue screening tests, and smoking and dietary assessment and counseling, supplemented by cancer education materials; or (2) controls. For each physician, we reviewed a random sample of 60 medical records for data about screening test, assessment, and counseling performance during 12-month preintervention and intervention periods. We calculated performance scores as percentage compliance with American Cancer Society and/or National Cancer Institute recommendations. Multiple regression analyses provided estimates of incremental differences in performance scores between intervention and control groups.
Controlling for preintervention performance levels, significant incremental differences in performance scores between intervention and control groups (P less than .05) were achieved for nine maneuvers: stool occult-blood test, +14.5; rectal examination, +10.5; pelvic examination, +11.8; Papanicolaou's smear, +30.7; breast examination, +8.7; smoking assessment, +10.2; smoking counseling, +17.3; dietary assessment, +12.3; and dietary counseling, +13.9. Increments for sigmoidoscopy and mammography were not significant.
Computerized reminders can significantly increase physicians' performance of cancer prevention activities in community-based practices.
以往促进癌症预防活动实施的干预措施主要针对大学附属医院的医生。
我们将40名社区基层医疗医生随机分为两组：（1）癌症预防提醒组，即由计算机生成的逾期筛查检查清单，以及吸烟和饮食评估与咨询，并辅以癌症教育材料；（2）对照组。对于每位医生，我们在干预前和干预期间的12个月内，随机抽取60份病历样本，以获取有关筛查检查、评估和咨询实施情况的数据。我们将实施率计算为符合美国癌症协会和/或美国国立癌症研究所建议的百分比。多元回归分析得出了干预组和对照组在实施率上的增量差异估计值。
在控制干预前的实施水平后，干预组和对照组在实施率上存在显著的增量差异（P<0.05），涉及九项操作：大便潜血试验，增加14.5；直肠检查，增加10.5；盆腔检查，增加11.8；巴氏涂片检查，增加30.7；乳房检查，增加8.7；吸烟评估，增加10.2；吸烟咨询，增加17.3；饮食评估，增加12.3；饮食咨询，增加13.9。乙状结肠镜检查和乳房X线摄影检查的增量不显著。
计算机化提醒可显著提高社区基层医疗中医生开展癌症预防活动的实施率。
