BMJ Editorial Office, BMJ Group, BMA House, Tavistock Square, London WC1H 9JR, UK.
BMC Med Educ. 2011 Jun 16;11:35. doi: 10.1186/1472-6920-11-35.
Methods for the dissemination, understanding and implementation of clinical guidelines need to be examined for their effectiveness to help doctors integrate guidelines into practice. The objective of this randomised controlled trial was to evaluate the effectiveness of an interactive online Diabetes Needs Assessment Tool (DNAT) (which constructs an e-learning curriculum based on individually identified knowledge gaps), compared with self-directed e-learning of diabetes guidelines.
Health professionals were randomised to a 4-month learning period and either given access to diabetes learning modules alone (control group) or DNAT plus learning modules (intervention group). Participants completed knowledge tests before and after learning (primary outcome), and surveys to assess the acceptability of the learning and changes to clinical practice (secondary outcomes).
Sixty four percent (677/1054) of participants completed both knowledge tests. The proportion of nurses (5.4%) was too small for meaningful analysis so they were excluded. For the 650 doctors completing both tests, mean (SD) knowledge scores increased from 47.4% (12.6) to 66.8% (11.5) [intervention group (n = 321, 64%)] and 47.3% (12.9) to 67.8% (10.8) [control group (n = 329, 66%)], (ANCOVA p = 0.186). Both groups were satisfied with the usability and usefulness of the learning materials. Seventy seven percent (218/284) of the intervention group reported combining the DNAT with the recommended reading materials was "very useful"/"useful". The majority in both groups (184/287, 64.1% intervention group and 206/299, 68.9% control group) [95% CI for the difference (-2.8 to 12.4)] reported integrating the learning into their clinical practice.
Both groups experienced a similar and significant improvement in knowledge. The learning materials were acceptable and participants incorporated the acquired knowledge into practice.
ISRCTN: ISRCTN67215088.
为了帮助医生将指南融入实践，需要对传播、理解和实施临床指南的方法进行评估，以了解其效果。本随机对照试验的目的是评估互动式在线糖尿病需求评估工具（DNAT）（根据个体确定的知识差距构建电子学习课程）的有效性，与糖尿病指南的自我指导电子学习相比。
将卫生专业人员随机分配到 4 个月的学习期，并分别提供糖尿病学习模块（对照组）或 DNAT 加学习模块（干预组）。参与者在学习前后完成知识测试（主要结果），并进行调查以评估学习的可接受性和对临床实践的改变（次要结果）。
64%（677/1054）的参与者完成了两项知识测试。由于护士人数（5.4%）太小，无法进行有意义的分析，因此将其排除在外。对于完成两项测试的 650 名医生，平均（SD）知识得分从 47.4%（12.6）增加到 66.8%（11.5）[干预组（n=321，64%）]和 47.3%（12.9）增加到 67.8%（10.8）[对照组（n=329，66%）]，（协方差分析 p=0.186）。两组对学习材料的可用性和有用性都很满意。干预组中 77%（218/284）的人报告说，将 DNAT 与推荐的阅读材料结合使用“非常有用”/“有用”。两组中的大多数人（干预组 287 人中有 184 人[64.1%]，对照组 299 人中有 206 人[68.9%]）[95%置信区间差值（-2.8 至 12.4）]报告将学习内容融入了他们的临床实践中。
两组的知识都有显著提高。学习材料是可以接受的，参与者将所学知识应用于实践。
ISRCTN: ISRCTN67215088。
