Veterans Affairs Boston Healthcare System, Massachusetts 02130, USA.
Am J Prev Med. 2010 Nov;39(5):472-8. doi: 10.1016/j.amepre.2010.07.016.
Prostate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines.
It was hypothesized that an e-mail-based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer.
The study was conducted as an RCT.
SETTING/PARTICIPANTS: The study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009.
Participants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers.
The primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or <40 years. Appropriateness of screening was dichotomized based on patient age at time of screening. Patients with PSA testing for non-screening reasons were excluded using a validated protocol. Logistic regression with adjustment for patient clustering by clinician was performed. Analyses were conducted in 2009.
During the intervention period (Weeks 1-36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p=0.041). Over the 72-week period following the intervention (Weeks 37-108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p=0.011), representing a 40% relative reduction in inappropriate screening.
Spaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.
前列腺癌筛查常采用前列腺特异性抗原（PSA）检测，但有悖于临床实践指南。
该研究为 RCT 试验。
2007 年 1 月至 2009 年 2 月，研究纳入了 8 家退伍军人事务部医疗中心的 95 名初级保健临床医生。
参与者被随机分为两组： spaced education 临床医生接受 4 个周期共 9 封电子邮件，每封邮件间隔一周，共 36 周（每周 0-2 封电子邮件）；而对照组临床医生不接受任何干预。每封电子邮件都提出一个临床场景，并询问是否适宜进行 PSA 检测。参与者提交答案后立即收到反馈。
主要结果是开具的不适当 PSA 筛查检测数量和百分比。不适当的检测定义为对年龄>76 岁或<40 岁的患者使用 PSA 进行前列腺癌筛查。根据筛查时患者的年龄将筛查的适宜性分为二分类。使用经过验证的方案排除了因非筛查原因进行 PSA 检测的患者。采用基于临床医生聚类的逻辑回归进行分析。分析于 2009 年进行。
在干预期间（第 1-36 周），接受 spaced education 电子邮件的临床医生开具的不适当 PSA 筛查检测数量明显少于对照组（10.5% vs 14.2%，p=0.041）。在干预结束后的 72 周（第 37-108 周）期间， spaced education 临床医生开具的不适当检测仍少于对照组（分别为 7.8% vs 13.1%，p=0.011），表明不适当筛查的相对减少了 40%。
spaced education 可持久改善临床医生前列腺癌筛查行为，为改善整个医疗体系中的患者护理提供了一种很有前途的新方法。
