University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
Medcast Pty Ltd., Sydney, NSW, Australia.
Trials. 2021 Aug 28;22(1):569. doi: 10.1186/s13063-021-05438-8.
There is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system.
The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention.
The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice.
ClinicalTrials.gov ACTRN12620000010998 . Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry.
提高初级保健水平是否能导致更合理地利用卫生资源，这是一个国际关注的问题。有证据表明，教育干预可以提高合理处方和检验订单的质量。澳大利亚新的共享病历国家平台 My Health Record（MHR）为系统全面实施带来了新的机遇和挑战。这项试验（CHIME-GP）将研究在澳大利亚普通诊所环境中，针对合理处方和调查订单的多方面教育干预的组成部分是否会导致在使用国家数字健康记录系统的情况下，减少卫生服务的利用和成本。
该试验将在澳大利亚的普通诊所进行。研究的目的是评估针对普通医生的基于网络的教育干预的组成部分的有效性，这些组成部分涉及在使用 MHR 系统的情况下合理使用药物、病理学和影像学。我们的目标是从澳大利亚城市和地区招募 120 名普通医生。我们将采用混合方法，包括三臂实用聚类随机平行试验和前瞻性定性研究。将使用其他两个臂作为对照来评估每个臂中每个教育组成部分的效果。评估将综合定性预/后访谈的结果，以调查干预的实施情况、临床行为的变化以及可能影响变化的态度等机制。主要结果是比较干预后 6 个月与干预前 6 个月每 100 次就诊选定处方、病理学和放射学检验订单的成本的经济分析。次要结果包括干预前后每 100 次就诊选定处方、病理学和放射学检验订单的比例，以及干预前后知识评估测试的比较。
该试验将在 MHR 背景下，对教育干预减少不必要的处方、病理学和影像学检验订单的证据进行强有力的健康经济分析。此外，该研究将有助于为改善初级保健实践中护理质量的干预措施的实施提供证据基础。
ClinicalTrials.gov ACTRN12620000010998. 于 2020 年 1 月 9 日在澳大利亚和新西兰临床试验注册中心注册。
