1Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
Med Care Res Rev. 2013 Oct;70(5):451-72. doi: 10.1177/1077558713496166. Epub 2013 Aug 5.
Primary care providers frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary care provider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework.
初级保健提供者经常推荐、管理或开处不太可能使患者受益的医疗服务。然而，对于如何减少提供者过度使用行为知之甚少。由于缺乏理论基础的因果框架，很难预测不同类型的减少提供者过度使用的干预措施在哪些情况下会成功，在哪些情况下会失败。在本文中，我们提出了一个基于计划行为理论的框架，旨在指导过度使用研究和干预措施的发展。我们描述了导致形成评估服务适当性意图的初级保健提供者信念类别，并提出了可能影响评估意图是否导致适当建议的因素。在该框架内审查了常用于解决提供者过度使用行为的干预措施。
