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遵循美国预防服务工作组女性筛查指南:内科住院医师培训项目经验

Adherence to the United States Preventative Services Task Force Female Screening Guidelines: An Internal Medicine Residency Program Experience.

作者信息

Alvarez Chikezie K, Mbianda Julvet, Nadeem Muhammad, Anwar Ansari Shahryar, Dirweesh Ahmed, Arsalan Mohammad, Fawwad Shaikh, DeBari Vincent A, Christmas Donald, Wallach Sara L

机构信息

Medicine, St. Francis Medical Center, Trenton, USA.

Internal Medicine, St. Francis Medical Center, Trenton, USA.

出版信息

Cureus. 2019 Jul 12;11(7):e5127. doi: 10.7759/cureus.5127.

Abstract

Background Various guidelines exist for female preventative screening tests and medical resident physician adherence to the United States Preventive Services Task Force (USPSTF) guidelines varies. National screening rates for breast cancer and osteoporosis have improved but they are still below the expected target. Material and methods Ambulatory medical clinic records of female patients from the period July 2015 to December 2017 were reviewed for breast cancer and osteoporosis screening. Resident performance and commitment with regards to ordering the aforementioned screening tests according to the USPSTF guidelines were compared to the most recent national screening rates for mammograms and dual-energy X-ray absorptiometry (DXA) scans. Results Of the 1327 charts reviewed, 1025 was included in the study. Of the 545 mammograms performed, 93% of them were indicated according to the USPSTF guidelines (P < 0.0001, 95% CI: 125.9-342.0). A total of 480 mammograms were not ordered, of which 6% were indicated and 93.9% were not indicated. Out of a total of 107 DXA scans performed, 88.7% were correctly indicated (P < 0.0001, 95% CI: 37.11-132.9). Conclusion Resident physician adherence to the USPSTF screening guidelines for breast cancer and DXA scans were higher than the national and state screening rates. Our well-structured educational project (strong faculty mentorship, resident to patient continuity of care and the reasonable resident-clinic load) resulted in higher screening rates.

摘要

背景 关于女性预防性筛查测试存在各种指南,而住院医师对美国预防服务工作组(USPSTF)指南的遵循情况各不相同。乳腺癌和骨质疏松症的全国筛查率有所提高,但仍低于预期目标。

材料与方法 回顾了2015年7月至2017年12月期间女性患者的门诊病历,以进行乳腺癌和骨质疏松症筛查。将住院医师根据USPSTF指南开具上述筛查测试的表现和依从性与最近的全国乳房X光检查和双能X线吸收测定(DXA)扫描筛查率进行比较。

结果 在审查的1327份病历中,1025份纳入研究。在进行的545次乳房X光检查中,93%是根据USPSTF指南进行的(P<0.0001,95%CI:125.9 - 342.0)。共有480次乳房X光检查未开具,其中6%是有指征的,93.9%是无指征的。在总共进行的107次DXA扫描中,88.7%开具正确(P<0.0001,95%CI:37.11 - 132.9)。

结论 住院医师对USPSTF乳腺癌和DXA扫描筛查指南的遵循率高于全国和州筛查率。我们结构完善的教育项目(强大的教师指导、住院医师对患者的连续护理以及合理的住院医师 - 诊所工作量)导致了更高的筛查率。

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