Center for Primary Care and Prevention, The Warren Alpert Medical School of Brown University and Memorial Hospital of Rhode Island, Pawtucket, RI, USA.
J Eval Clin Pract. 2010 Dec;16(6):1136-41. doi: 10.1111/j.1365-2753.2009.01282.x.
Laboratory monitoring has been increasingly recognized as an important area for improving patient safety in ambulatory care. Little is known about doctors' attitudes towards laboratory monitoring and potential ways to improve it.
Six focus groups and one individual interview with 20 primary care doctors and nine specialists from three Massachusetts communities.
Participants viewed laboratory monitoring as a critical, time-consuming task integral to their practice of medicine. Most believed they commit few laboratory monitoring errors and were surprised at the error rates reported in the literature. They listed various barriers to monitoring, including not knowing which doctor was responsible for ensuring the completion of laboratory monitoring, uncertainty regarding the necessity of monitoring, lack of alerts/reminders and patient non-adherence with recommended monitoring. The primary facilitator of monitoring was ordering laboratory tests while the patient is in the office. Primary care doctors felt more strongly than specialists that computerized alerts could improve laboratory monitoring. Participants wanted to individualize alerts for their practices and warned that alerts must not interrupt work flow or require too many clicks.
Doctors in community practice recognized the potential of computerized alerts to enhance their monitoring protocols for some medications. They viewed patient non-adherence as a barrier to optimal monitoring. Interventions to improve laboratory monitoring should address doctor workflow issues, in addition to patients' awareness of the importance of fulfilling recommended therapeutic monitoring to prevent adverse drug events.
实验室监测已逐渐被视为改善门诊患者安全的一个重要领域。目前对于医生对实验室监测的态度以及改善其监测工作的潜在方法知之甚少。
在马萨诸塞州的三个社区中，我们对 20 名初级保健医生和 9 名专科医生进行了 6 次焦点小组讨论和 1 次个人访谈。
参与者认为实验室监测是一项至关重要且耗时的任务，是其医疗实践不可或缺的一部分。大多数医生认为他们很少犯实验室监测错误，对文献中报告的错误率感到惊讶。他们列举了监测的各种障碍，包括不知道哪位医生负责确保实验室监测的完成、对监测必要性的不确定、缺乏警报/提醒以及患者不遵守推荐的监测。监测的主要促进因素是在患者就诊时开实验室检查单。初级保健医生比专科医生更强烈地认为计算机化的警报可以改善实验室监测。参与者希望为其实践个性化警报，并警告说警报不能打断工作流程或需要太多点击。
社区实践中的医生认识到计算机化警报在增强他们对某些药物监测协议方面的潜力。他们认为患者不遵医嘱是实现最佳监测的障碍。改善实验室监测的干预措施应解决医生的工作流程问题，同时还要提高患者对遵医嘱进行治疗性监测以预防药物不良事件的重要性的认识。
