Tehran University of Medical Sciences (TUMS), Tehran, Iran.
J Eval Clin Pract. 2013 Feb;19(1):16-24. doi: 10.1111/j.1365-2753.2011.01761.x. Epub 2011 Aug 30.
To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders.
Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change ('intention') and a 2-day interactive large group meeting for those with lower propensity to change ('attitude') at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention.
GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001).
Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.
评估基于三阶段修正的变化准备度普罗查斯卡模型的定制化和激发式教育干预对初级保健医生（全科医生）管理抑郁障碍的表现的影响。
平行组、随机对照试验。主要假设是干预组的表现会提高 20 个百分点。研究地点为德黑兰南部的初级保健。参与者为 192 名按变化准备度阶段、性别、年龄和工作经验分层的全科医生。干预措施是为期两天的互动小组工作坊，为处于更高变化准备度阶段（“意向”）的一小部分医生提供，以及为期两天的互动大组会议，为那些改变意愿较低的医生提供（“态度”）在预评估时。对照组的医生参加了同一主题的标准教育计划。主要结局指标是通过未宣布的标准化患者评估医生表现的有效工具，评估抑郁障碍的诊断和治疗。评估在干预前 2 个月和干预后 2 个月进行。
干预组的医生在诊断和治疗以及转介方面的整体表现评分均显著提高，诊断的干预效果为 14 个百分点（P = 0.007），治疗和转介的干预效果为 20 个百分点（P < 0.0001）。干预后最大的改善出现在小团体中：诊断提高了 30 个百分点（P = 0.027），治疗和转介提高了 29 个百分点（P < 0.0001）。
根据参与者的变化准备度定制的激活学习方法提高了全科医生在继续医学教育中的临床表现，可以推荐用于继续专业发展。
