Pimenta Henderson Barbosa, Caldeira Antonio Prates, Mamede Sílvia
J Contin Educ Health Prof. 2014 Fall;34(4):243-51. doi: 10.1002/chp.21252.
Experimental studies on the effectiveness of educational interventions to improve patient care are scarce, especially for low-resources settings. This study investigated the effects of 2 educational interventions on the treatment of hypertensive patients in primary health care in Brazil.
Forty-one physicians were randomly assigned either to an "active educational intervention" (21 physicians) or to a "passive educational intervention" (20 physicians). The former comprised 1 small group discussion of routine practices, 1 outreach visit, and 3 reminders. The latter consisted of delivery of printed guidelines. Measures of quality of treatment provided for hypertensive patients (181 patients of physicians from the active intervention; 136 patients of physicians from the passive intervention) were obtained through patient interview and charts review, before and 3 months after the intervention. Chi-square and independent t-tests were performed for comparison between the conditions.
The groups did not differ before the study. After the intervention, the active intervention group outperformed the passive intervention group in several measures, such as improved prescription of antihypertensive drugs (80% of patients of physicians from the active intervention vs 51% patients of physicians from the passive intervention; p < .01), prescription of aspirin (18% vs 6%; p < .01) and hypolipidemic drugs for high-risk patients (39% vs 21%; p < .01), dietary counseling (76% vs 61%; p < .01), guidance on cardiovascular risk (20% vs 3%; p < .01). Patient outcomes did not differ.
A multifaceted intervention based on review of practices improved treatment of hypertensive patients in a low-resource setting whereas delivery of guidelines did not help. None of the interventions affected patient outcomes.
关于教育干预措施改善患者护理效果的实验研究很少，尤其是在资源匮乏地区。本研究调查了两种教育干预措施对巴西初级卫生保健中高血压患者治疗的影响。
41名医生被随机分为“积极教育干预组”（21名医生）或“被动教育干预组”（20名医生）。前者包括1次常规实践小组讨论、1次外展访问和3次提醒。后者包括提供印刷指南。通过患者访谈和病历审查，在干预前和干预后3个月获得了为高血压患者提供的治疗质量指标（积极干预组医生的181名患者；被动干预组医生的136名患者）
研究前两组无差异。干预后，积极干预组在多项指标上优于被动干预组，如改善降压药处方（积极干预组医生的患者中有80%，被动干预组医生的患者中有51%；p <.01）、阿司匹林处方（18%对6%；p <.01）和高危患者的降脂药处方（39%对21%；p <.01）、饮食咨询（76%对61%；p <.01）、心血管风险指导（20%对3%；p <.01）。患者结局无差异。
基于实践审查的多方面干预改善了资源匮乏地区高血压患者的治疗，而提供指南则没有帮助。两种干预措施均未影响患者结局。
