Atwood Katharine A, Shamblen Stephen R, Gaudet Tracy, Rindfleisch Adam, Collins David A, Milovani Christine, Greenfield Russell, Kiefer David, Rakel David
Pacific Institute for Research and Evaluation.
Fam Med. 2016 Oct;48(9):711-719.
The purpose of this study was to assess whether a 2.5 day clinical education course focused on integrative medicine (IM), complementary health (CH), and patient-centered care strategies delivered to staff at Veteran Health Administration (VHA) facilities resulted in changes in attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies. The study also assessed whether there were differential impacts by participant characteristics.
The study used a pre-post intervention group-only design with participants who completed self-report pre, post, and 2-month follow-up surveys. The course was delivered to 15 VHA facilities, reaching a total of 655 participants with 407 participants completing the 2-month follow-up survey (65% response rate).
Findings suggest that the clinical course was associated with changes in all outcomes at the 2-month follow-up, including attitudes, self-efficacy to engage in IM strategies, institutional support, perceived preparedness to discuss non-pharmaceutical approaches to care, intentions to engage in IM strategies, and greater engagement in IM behaviors during clinical encounters. Differential impacts were found for younger participants, longer tenured staff, non-nursing compared to nursing staff, and among those who volunteered as opposed to those who were required to attend.
The study found significant positive changes in all outcomes measured at the 2-month follow-up. Positive impacts were found across a variety of participant characteristics. Findings suggest that this brief experiential course, designed to be a foundational strategy in driving transformation is effective in shifting attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies.
本研究的目的是评估针对退伍军人健康管理局（VHA）设施工作人员开展的为期2.5天的聚焦整合医学（IM）、补充健康（CH）和以患者为中心的护理策略的临床教育课程，是否会导致态度、自我效能感、准备情况、意愿以及自我报告的IM策略使用情况发生变化。该研究还评估了参与者特征是否会产生不同影响。
本研究采用仅设干预组的前后测设计，参与者完成自我报告的前测、后测及2个月随访调查。该课程在15个VHA设施中开展，共有655名参与者，其中407名参与者完成了2个月随访调查（回复率为65%）。
研究结果表明，在2个月随访时，该临床课程与所有结果的变化相关，包括态度、采用IM策略的自我效能感、机构支持、对讨论非药物护理方法的感知准备情况、采用IM策略的意愿，以及在临床接触中更多地采用IM行为。在年轻参与者、任期较长的工作人员、非护理人员与护理人员之间，以及自愿参加者与要求参加者之间发现了不同影响。
该研究发现在2个月随访时所测量的所有结果均有显著的积极变化。在各种参与者特征中均发现了积极影响。研究结果表明，这一简短的体验式课程作为推动变革的基础策略，在改变态度、自我效能感、准备情况、意愿以及自我报告的IM策略使用方面是有效的。
