University of Colorado Denver, Department of Family Medicine, 12681 East 17th Ave, Bldg. A01, Mail Stop 496, Aurora, CO 80045-0508, USA.
Implement Sci. 2011 Jun 26;6:65. doi: 10.1186/1748-5908-6-65.
There are often disparities between current evidence and current practice. Decreasing the gap between desired practice outcomes and observed practice outcomes in the healthcare system is not always easy. Stopping previously recommended or variably recommended interventions may be even harder to achieve than increasing the use of a desired but under-performed activity. For over a decade, aspirin has been prescribed for primary prevention of cardiovascular disease and for patients with the coronary artery disease risk equivalents; yet, there is no substantial evidence of an appropriate risk-benefit ratio to support this practice. This paper describes the protocol of a randomized trial being conducted in six primary care practices in the Denver metropolitan area to examine the effectiveness of three interventional strategies to change physician behavior regarding prescription of low-dose aspirin.
All practices received academic detailing, one arm received clinician reminders to reconsider aspirin, a second arm received both clinician and patient messages to reconsider aspirin. The intervention will run for 15 to 18 months. Data collected at baseline and for outcomes from an electronic health record will be used to assess pre- and post-interventional prescribing, as well as to explore any inappropriate decrease in aspirin use by patients with known cardiovascular disease.
This study was designed to investigate effective methods of changing physician behavior to decrease the use of aspirin for primary cardiovascular disease prevention. The results of this study will contribute to the small pool of knowledge currently available on the topic of ceasing previously supported practices.
ClinicalTrials.gov: NCT01247454.
当前证据与当前实践之间常常存在差距。在医疗保健系统中，缩小期望的实践结果与观察到的实践结果之间的差距并不总是那么容易。停止以前推荐或可变推荐的干预措施可能比增加所需但表现不佳的活动的使用更难实现。十多年来，阿司匹林一直被用于心血管疾病的一级预防和有冠状动脉疾病风险等价物的患者；然而，没有充分的证据表明适当的风险效益比来支持这种做法。本文描述了一项正在丹佛大都市区的六个初级保健机构进行的随机试验的方案，以检验三种干预策略改变医生对低剂量阿司匹林处方行为的有效性。
所有实践都接受了学术细节，一个手臂接受了重新考虑阿司匹林的临床医生提醒，另一个手臂同时接受了临床医生和患者的信息来重新考虑阿司匹林。干预将持续 15 到 18 个月。从电子健康记录中收集的基线数据和结果数据将用于评估干预前后的处方情况，并探索任何已知心血管疾病患者阿司匹林使用的不适当减少。
这项研究旨在调查改变医生行为以减少阿司匹林用于一级心血管疾病预防的有效方法。这项研究的结果将有助于目前关于停止以前支持的实践的有限知识的研究。
ClinicalTrials.gov：NCT01247454。
