医生继续医学教育对患者报告的阻塞性睡眠呼吸暂停识别及优化管理结果的影响。

The effect of physician continuing medical education on patient-reported outcomes for identifying and optimally managing obstructive sleep apnea.

作者信息

Johnson Sara S, Castle Patricia H, Van Marter Deborah, Roc Anne, Neubauer David

出版信息

J Clin Sleep Med. 2015 Mar 15;11(3):197-204. doi: 10.5664/jcsm.4524.

DOI:10.5664/jcsm.4524

PMID:25845903

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4346639/

Abstract

STUDY OBJECTIVE

To evaluate the effect of continuing medical education (CME) activities on patient reported outcomes with regard to (1) screening for excessive sleepiness (ES) and obstructive sleep apnea (OSA) and (2) appropriate referral and treatment.

METHODS

A total of 725 patients were recruited from 75 providers who either participated or did not participate in Transtheoretical Model (TTM)-based OSA CME activities. Patient reported outcomes from participating (n = 36) and non-participating providers (n = 39) were compared using generalized estimating equations examining random effects of provider as unit of assignment.

RESULTS

Patients' reports demonstrate that participating physicians were 1.7 times more likely to initiate discussion of sleep problems than non-participating physicians (t1,411 = 3.71, p = 0.05) and 2.25-2.86 times more likely to administer validated measures for OSA (Epworth Sleepiness Scale and STOP-BANG). Patient reports also indicated that participating clinicians (79.9%) were significantly more likely to recommend seeing a sleep specialist compared to non-participating clinicians (60.7%; t1,348 = 9.1, p < 0.01, OR = 2.6). Furthermore, while 89.4% of participating clinicians recommended a sleep study, only 73.2% of the non-participating physicians recommended one (t1,363 = 11.46, p < 0.001, OR = 3.1).

CONCLUSIONS

Participation in TTM-based OSA CME activities was associated with improved patient reported outcomes compared to the non-participating clinicians.

摘要

研究目的

评估继续医学教育（CME）活动对患者报告结局的影响，具体涉及（1）过度嗜睡（ES）和阻塞性睡眠呼吸暂停（OSA）的筛查，以及（2）适当的转诊和治疗。

方法

从75家医疗机构招募了725名患者，这些机构要么参与了基于跨理论模型（TTM）的OSA CME活动，要么未参与。使用广义估计方程比较参与活动的医疗机构（n = 36）和未参与活动的医疗机构（n = 39）的患者报告结局，以医疗机构作为分配单位检验随机效应。

结果

患者报告显示，参与活动的医生发起睡眠问题讨论的可能性比未参与的医生高1.7倍（t1,411 = 3.71，p = 0.05），进行OSA有效测量（爱泼沃斯嗜睡量表和STOP - BANG）的可能性高2.25 - 2.86倍。患者报告还表明，与未参与的临床医生（60.7%）相比，参与活动的临床医生（79.9%）更有可能推荐患者去看睡眠专家（t1,348 = 9.1，p < 0.01，OR = 2.6）。此外，虽然89.4%参与活动的临床医生推荐进行睡眠研究，但只有73.2%未参与的医生推荐（t1,363 = 11.46，p < 0.001，OR = 3.1）。