CE Outcomes, LLC, Birmingham, Alabama, USA.
Pediatr Pulmonol. 2012 May;47(5):434-40. doi: 10.1002/ppul.21573. Epub 2012 Jan 3.
To examine cystic fibrosis (CF) physician adherence to the 2007 CF Foundation (CFF) Pulmonary Guidelines for Chronic Medications. Specifically adherence and barriers to prescribing level A medication recommendations (i.e., inhaled tobramycin and dornase alfa) and level B medication recommendations (i.e., macrolide antibiotics and hypertonic saline) were studied.
During Spring 2010, the CFF emailed survey invitations to directors of 136 accredited CF care centers treating 50+ CF patients. Directors were asked to forward the invitations to their physician colleagues. One hundred thirty-three surveys were included in the analyses, representing 92 centers. Barriers were conceptualized based on Cabana et al.'s framework for adherence to guidelines. Adherence was assessed via a case vignette.
Logistic regression analysis revealed that higher outcome expectancy (OR = 1.099, CI 1.010-1.196) and fewer environmental/system barriers (OR = 1.484, CI 1.158-1.902) were significantly associated with Vignette Adherence. A trend for an association between Familiarity and Vignette Adherence (OR = 1.642, CI 0.953-2.828) was evident, while no demographic variables were significantly associated with Vignette Adherence.
Targeting outcome expectancy and external barriers with multifaceted, ongoing interventions may improve guideline adherence. Pulmonologists are clearly looking for empirical evidence that these medications benefit their patients over the long-term and offset patient treatment burden with improved health.
检查囊性纤维化 (CF) 医生对 2007 年 CF 基金会 (CFF) 慢性药物治疗肺部指南的遵守情况。具体来说，研究了开具 A 级药物推荐（即吸入妥布霉素和脱氧核糖核酸酶阿尔法）和 B 级药物推荐（即大环内酯类抗生素和高渗盐水）的遵守情况和障碍。
2010 年春季，CFF 通过电子邮件向治疗 50 多名 CF 患者的 136 家认证 CF 护理中心的主任发送了调查邀请。主任们被要求将邀请转发给他们的医生同事。133 份调查被纳入分析，代表 92 个中心。根据 Cabana 等人的指南依从性框架，将障碍概念化。通过病例情节评估依从性。
逻辑回归分析显示，较高的结果预期（OR=1.099，CI 1.010-1.196）和较少的环境/系统障碍（OR=1.484，CI 1.158-1.902）与情节依从性显著相关。熟悉程度与情节依从性之间存在关联的趋势（OR=1.642，CI 0.953-2.828），而没有任何人口统计学变量与情节依从性显著相关。
通过多方面的持续干预来针对结果预期和外部障碍，可能会提高指南的依从性。肺科医生显然在寻找这些药物对患者长期受益的经验证据，并通过改善健康状况来减轻患者的治疗负担。
