持续医学教育干预后的变革承诺声明与实际实践变革

Commitment to Change Statements and Actual Practice Change After a Continuing Medical Education Intervention.

作者信息

Arnold Rehring Sharisse M, Steiner John F, Reifler Liza M, Glenn Karen A, Daley Matthew F

机构信息

Dr. Arnold Rehring: Director, Department of Medical Education, Colorado Permanente Medical Group, Denver, CO, and Clinical professor, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO. Dr. Steiner: Senior Investigator, Department of Medical Education, Colorado Permanente Medical Group, Denver, CO, and Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, and Professor, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO. Ms. Reifler: Biostatistician, Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO. Ms. Glenn: Data specialist, Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO. Dr. Daley: Associate Professor, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, and Senior Investigator, Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.

出版信息

J Contin Educ Health Prof. 2021 Apr 1;41(2):145-152. doi: 10.1097/CEH.0000000000000340.

DOI:10.1097/CEH.0000000000000340

PMID:33758129

Abstract

INTRODUCTION

Continuing medical education (CME) interventions often evaluate participant commitment to change (CTC) clinical practice. Evidence linking CTC to actual practice change is limited.

METHODS

In an intervention that combined live CME with changes to the electronic health record to promote judicious antibiotic use for children with urinary tract infections (UTIs), we evaluated CTC and subsequent prescribing behavior in Kaiser Permanente Colorado, an integrated health care system. CTC was assessed immediately after the session using closed-ended questions about session learning objectives and open-ended questions to elicit specific practice changes. Perceived barriers to implementing recommended changes were also assessed.

RESULTS

Among 179 participants, 80 (45%) completed postsession evaluations and treated one or more child with a UTI in the subsequent 17 months (856 UTIs in total). In closed-ended responses about session learning objectives, 45 clinicians (56%) committed to changing practice for antibiotic choice and duration, whereas 37 (46%) committed to implementing new practice guidelines. When asked open-ended questions to identify specific practice changes, 32 (40%) committed to antibiotic choice change and 29 (36%) committed to treatment duration change. Participants who made specific CTC statements had greater improvement in antibiotic choice (relative rate ratio 1.56, 95% CI 1.16-2.09) and duration (relative rate ratio 1.59, 95% CI 1.05-2.41) than participants who did not make specific commitments. Few perceived barriers affected subsequent prescribing.

DISCUSSION

Commitments to changing specific clinical behaviors were associated with sustained changes in prescribing for children with UTIs. Linking self-evaluations with clinical data in integrated health care systems is an important tool for CME evaluators.

摘要

引言

继续医学教育（CME）干预措施通常会评估参与者对改变临床实践的承诺（CTC）。将CTC与实际实践改变联系起来的证据有限。

方法

在一项将现场CME与电子健康记录的更改相结合以促进对患有尿路感染（UTI）的儿童合理使用抗生素的干预措施中，我们在综合医疗保健系统科罗拉多州凯撒医疗机构评估了CTC及随后的处方行为。在课程结束后，使用关于课程学习目标的封闭式问题和开放式问题来评估CTC，以引出具体的实践改变。还评估了实施推荐改变的感知障碍。

结果

在179名参与者中，80名（45%）完成了课后评估，并在随后的17个月内治疗了一名或多名患有UTI的儿童（总共856例UTI）。在关于课程学习目标的封闭式回答中，45名临床医生（56%）承诺改变抗生素选择和疗程的实践，而37名（46%）承诺实施新的实践指南。当被问及开放式问题以确定具体的实践改变时，32名（40%）承诺改变抗生素选择，29名（36%）承诺改变治疗疗程。做出具体CTC声明的参与者在抗生素选择（相对率比1.56，95%可信区间1.16 - 2.09）和疗程（相对率比1.59，95%可信区间1.05 - 2.41）方面的改善比未做出具体承诺的参与者更大。很少有感知障碍影响随后的处方。