David Geffen School of Medicine and Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
Pediatrics. 2013 Sep;132(3):517-34. doi: 10.1542/peds.2013-0779. Epub 2013 Aug 26.
Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes.
Data sources included Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, and Research and Development Resource Base in Continuing Medical Education up to July 2012. Paired investigators independently assessed study eligibility. Investigators abstracted data sequentially and independently graded the evidence.
Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-for-performance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance.
Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes.
医疗保健提供者对哮喘指南的依从性很差。本研究的目的是评估改善医疗保健提供者对哮喘指南的依从性的干预措施对医疗保健过程和临床结果的影响。
资料来源包括 Medline、Embase、Cochrane 中心对照试验注册库、护理学和联合健康文献累积索引、教育资源信息中心、PsycINFO 和继续医学教育研究与发展资源基础，检索时间截至 2012 年 7 月。配对的调查员独立评估研究的纳入性。调查员依次独立提取数据并对证据进行分级。
68 项符合纳入标准的研究按干预措施进行分类：决策支持、组织变革、反馈和审核、临床药学支持、单纯教育、质量改进/按绩效付费、多组分和信息支持。其中有一半是随机试验（n = 35）。决策支持、反馈和审核以及临床药学支持可增加控制性药物的处方，组织变革和多组分干预可提供低级别证据。有中等质量证据支持使用决策支持和临床药学干预来增加患者自我教育/哮喘行动计划的提供。有中等质量证据支持使用决策支持工具来减少急诊就诊次数，而组织变革、单纯教育和质量改进/按绩效付费干预对此结局没有益处的证据为低级别。
决策支持工具、反馈和审核以及临床药学支持最有可能通过医疗保健过程结果来改善提供者对哮喘指南的依从性。需要用标准化结局来评估以医疗保健提供者为目标的干预措施。
