Department of Pediatrics, University of Connecticut Health Center, Farmington, CT, USA.
Acad Pediatr. 2012 Jul-Aug;12(4):312-8. doi: 10.1016/j.acap.2012.04.004. Epub 2012 May 26.
The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).
A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy.
At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04-1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29-1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92-3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes.
Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.
本研究旨在展示临床医生自我效能感和改变准备度的变化与哮喘管理计划（轻松呼吸）实施之间的关联。
进行了一项为期 36 个月的随机对照试验，涉及 24 家儿科诊所（88 名临床医生）。随机分配的临床医生接受了旨在增强临床医生自我效能感和改变准备度的干预措施，这些干预措施在基线和 3 年后进行了测量。干预措施包括教育工具包、研讨会、电话会议、小型奖学金、意见领袖访问、临床医生特定的反馈以及绩效薪酬。主要结果是计划利用率（每年注册 Easy Breathing 的儿童人数）；次要结果包括制定书面治疗计划和使用适当严重程度的治疗方法。
基线时，每位临床医生每年为 149 ± 147 名儿童/临床医生/年注册（平均值 ± 标准差）；84%的儿童有书面治疗计划，77%的计划使用了适当严重程度的治疗方法。基线时，较高的自我效能感评分与更高的计划利用率相关（相对比率 [RR]，1.34；95%置信区间 [CI]，1.04-1.72；P =.04），但与治疗计划的制定（RR，0.63；95% CI，0.29-1.35；P =.23）或抗炎药的使用（RR，1.76；95% CI，0.92-3.35；P =.09）无关。干预组的临床医生在 36 个月内参与了 17 项干预措施。研究结束时，与对照组临床医生相比，干预组的自我效能感评分增加（P =.01），更多的临床医生处于改变的行动阶段（P =.001），但这些变化与主要或次要结果的变化无关。
自我效能感评分与基线时的计划使用率相关，在干预组中增加，但这些增加与更多的与计划相关的活动无关。自我效能感可能是必要的，但不足以改变行为。
