Banks Anke, Samuel Susan, Johnson David, Hecker Kent, McLaughlin Kevin
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Can Med Educ J. 2018 Nov 12;9(4):e6-e14. eCollection 2018 Nov.
Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children.
Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model.
One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]).
Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.
医生常常未能执行临床实践指南。我们的目的是评估一种经过精心排序的多方面教育干预措施是否会提高医生对幼儿首次尿路感染（UTI）后使用排尿性膀胱尿道造影（VCUG）指南的遵循程度。
采用单中心、前后测试设计，我们比较了根据PRECEDE（教育诊断与评估中的 predisposing、强化和促成因素）健康促进模型选择并排序的三种教育干预措施（互动讲座、临床路径、传真提醒）前后遵循指南的VCUG医嘱比例和VCUG医嘱开具率。
109名医生为219名儿童开具了219次VCUG检查。干预后，儿科医生开具的遵循指南的VCUG检查的月度比例有所增加（方差分析（ANOVA）F(2,29) = 3.38，p = .048），非儿科医生也是如此（ANOVA F(2,28) = 14.71，p < .001）。此外，儿科医生降低了他们的月度VCUG医嘱开具率（线性趋势发病率比0.74，95%置信区间（CI）[0.54, 0.99]）。儿科医生比非儿科医生更有可能遵循指南（优势比2.91，95% CI [1.5, 5.5]）。
接受基于PRECEDE模型的精心排序的教育干预措施与提高对指南建议的遵循程度相关。
