评估一项低成本干预措施对提高医疗机构对数据的参与度及改变处方行为的影响：一项英国初级医疗的随机试验。
Evaluating the impact of a very low-cost intervention to increase practices' engagement with data and change prescribing behaviour: a randomized trial in English primary care.
作者信息
Curtis Helen J, Bacon Seb, Croker Richard, Walker Alex J, Perera Rafael, Hallsworth Michael, Harper Hugo, Mahtani Kamal R, Heneghan Carl, Goldacre Ben
机构信息
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
出版信息
Fam Pract. 2021 Jul 28;38(4):373-380. doi: 10.1093/fampra/cmaa128.
BACKGROUND
Unsolicited feedback can solicit changes in prescribing.
OBJECTIVES
Determine whether a low-cost intervention increases clinicians' engagement with data, and changes prescribing; with or without behavioural science techniques.
METHODS
Randomized trial (ISRCTN86418238). The highest prescribing practices in England for broad-spectrum antibiotics were allocated to: feedback with behavioural impact optimization; plain feedback; or no intervention. Feedback was sent monthly for 3 months by letter, fax and email. Each included a link to a prescribing dashboard. The primary outcomes were dashboard usage and change in prescribing.
RESULTS
A total of 1401 practices were randomized: 356 behavioural optimization, 347 plain feedback, and 698 control. For the primary engagement outcome, more intervention practices had their dashboards viewed compared with controls [65.7% versus 55.9%; RD 9.8%, 95% confidence intervals (CIs): 4.76% to 14.9%, P < 0.001]. More plain feedback practices had their dashboard viewed than behavioural feedback practices (69.1% versus 62.4%); but not meeting the P < 0.05 threshold (6.8%, 95% CI: -0.19% to 13.8%, P = 0.069). For the primary prescribing outcome, intervention practices possibly reduced broad-spectrum prescribing to a greater extent than controls (1.42% versus 1.12%); but again not meeting the P < 0.05 threshold (coefficient -0.31%, CI: -0.7% to 0.1%, P = 0.104). The behavioural impact group reduced broad-spectrum prescribing to a greater extent than plain feedback practices (1.63% versus 1.20%; coefficient 0.41%, CI: 0.007% to 0.8%, P = 0.046). No harms were detected.
CONCLUSIONS
Unsolicited feedback increased practices' engagement with data, with possible slightly reduced antibiotic prescribing (P = 0.104). Behavioural science techniques gave greater prescribing effects. The modest effects on prescribing may reflect saturation from similar initiatives on antibiotic prescribing.
CLINICAL TRIAL REGISTRATION
ISRCTN86418238.
背景
主动提供的反馈意见可以促使处方开具发生改变。
目的
确定一项低成本干预措施是否能提高临床医生对数据的参与度，并改变处方开具情况；无论是否采用行为科学技术。
方法
随机试验（ISRCTN86418238）。将英格兰地区广谱抗生素处方开具量最高的医疗机构分为：行为影响优化反馈组；普通反馈组；或无干预组。通过信件、传真和电子邮件每月发送3个月的反馈意见。每份反馈意见都包含一个指向处方仪表盘的链接。主要结局指标为仪表盘的使用情况和处方开具的变化。
结果
共1401家医疗机构被随机分组：356家为行为优化组，347家为普通反馈组，698家为对照组。对于主要的参与度结局指标，与对照组相比，更多接受干预的医疗机构查看了其仪表盘[65.7%对55.9%；风险差值9.8%，95%置信区间（CI）：4.76%至14.9%，P<0.001]。查看仪表盘的普通反馈组医疗机构多于行为反馈组（69.1%对62.4%）；但未达到P<0.05的阈值（6.8%，95%CI：-0.19%至13.8%，P = 0.069）。对于主要的处方开具结局指标，干预组医疗机构可能比对照组更大程度地减少了广谱抗生素的处方开具（1.42%对1.12%）；但同样未达到P<0.05的阈值（系数-0.31%，CI：-0.7%至0.1%），P =
0.104）。行为影响组比普通反馈组更大程度地减少了广谱抗生素的处方开具（1.63%对1.20%；系数0.41%，CI：0.007%至0.8%，P = 0.046）。未检测到不良影响。
结论
主动提供的反馈意见提高了医疗机构对数据的参与度，可能略微减少了抗生素的处方开具（P = 0.104）。行为科学技术产生了更大的处方开具效果。对处方开具的适度影响可能反映了抗生素处方开具方面类似举措的饱和效应。
临床试验注册编号
ISRCTN86418238。
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