电子即时提醒与每月反馈对改善初级保健中 10 项临床推荐依从性的效果：一项群组随机临床试验。
Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial.
机构信息
Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Sistema de Informació pel Desenvolupament d'Investigació en Atenció Primària (SIDIAP), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
出版信息
BMC Med Inform Decis Mak. 2019 Nov 29;19(1):245. doi: 10.1186/s12911-019-0976-8.
BACKGROUND
Numerous studies have analyzed the effectiveness of electronic reminder interventions to improve different clinical conditions, and most have reported a small to moderate effect. Few studies, however, have analyzed reminder systems targeting multiple conditions, and fewer still have compared electronic point-of-care reminders systems with other forms of feedback designed to improve delivery of care.
METHODS
We performed an unblinded cluster randomized clinical trial to compare the effectiveness of an electronic point-of-care reminder system with that of a well-established system providing monthly feedback on adherence to clinical recommendations. The control group received monthly feedback only while the intervention group received monthly feedback in addition to on-screen point-of-care reminders for 10 clinical conditions. The study targeted all physicians and nurses at the 283 primary care centers managed by the Institut Català de la Salut (approximately 6600 professionals).
RESULTS
Following exclusions and randomization, 132 primary care centers (328,728 patients with reminders) were assigned to the intervention group while 137 centers (317,117 patients with reminders) were randomized to the control group. A 20.6% improvement (OR 1.29, 95% CI: 1.25-1.34) in reminder resolution rates was observed in the intervention group. Results varied according to the clinical condition. The most effective reminder was screening for diabetic retinopathy (OR 1.51, 95% CI:1.46-1.57) while the least effective reminders were measurement of glycated hemoglobin (OR: 1.10, 95% CI: 1.07-1.13) and smoking cessation encouragement (OR 1.12, 95% CI: 1.09-1.16).
CONCLUSIONS
Electronic point-of-care reminders were more effective than the existing monthly feedback system at resolving the 10 clinical situations. However, more studies are needed to investigate the variations of the effect observed.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN42391639, 08/10/2012. Retrospectively registered.
背景
许多研究分析了电子提醒干预对改善不同临床情况的有效性，大多数研究报告了小到中等的效果。然而，很少有研究分析针对多种情况的提醒系统，更少的研究比较了针对多个临床情况的电子即时提醒系统与其他旨在改善护理提供的反馈形式。
方法
我们进行了一项非盲、集群随机临床试验，比较了电子即时提醒系统与提供每月临床建议依从性反馈的成熟系统的有效性。对照组仅接受每月反馈，而干预组除了每月反馈外，还针对 10 种临床情况提供屏幕即时提醒。该研究针对 Institut Català de la Salut 管理的 283 个初级保健中心（约 6600 名专业人员）的所有医生和护士。
结果
排除和随机分组后，132 个初级保健中心（328728 名患者有提醒）被分配到干预组，而 137 个中心（317117 名患者有提醒）被随机分配到对照组。干预组的提醒解决率提高了 20.6%（比值比 1.29，95%置信区间：1.25-1.34）。结果因临床情况而异。最有效的提醒是糖尿病视网膜病变筛查（比值比 1.51，95%置信区间：1.46-1.57），而效果最差的提醒是糖化血红蛋白测量（比值比：1.10，95%置信区间：1.07-1.13）和戒烟鼓励（比值比 1.12，95%置信区间：1.09-1.16）。
结论
电子即时提醒在解决 10 种临床情况方面比现有的每月反馈系统更有效。然而，需要更多的研究来调查观察到的效果变化。
试验注册
当前对照试验 ISRCTN42391639，2012 年 10 月 8 日。回顾性注册。
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