Cohen S J, Weinberger M, Hui S L, Tierney W M, McDonald C J
Soc Sci Med. 1985;21(8):909-14. doi: 10.1016/0277-9536(85)90147-9.
In order to increase physicians' adherence to recommended standards of medical care and to examine factors presumed to contribute to such changes, we conducted a randomized, controlled trial using reading materials targeted to specific practice recommendations. Seventy-nine internal medicine residents completed baseline questionnaires stating their intentions to follow 13 common preventive care actions. They were randomly assigned to receive one of two different sets of readings covering these care actions. Thus, each physician was in the experimental group for one set of readings (A or B) while serving as a control for the other set. The impact of the reading was determined by: the physicians' knowledge of the recommended care actions detailed in the combined readings, their post-reading intentions, and clinical behavior when faced with patients having indications for the recommended actions. The 73 residents (92%) who read the material judged 39% of the information to be new and 72% useful. Residents had significantly better performance on the knowledge questions based on their own readings than did their control group peers for both sets of readings. For the Group A physicians, reading significantly (P less than 0.05) increased intentions to follow one of the seven clinical actions while Group B residents increased their intentions in three out of six. Step-wise multiple regression analyses were used to predict physicians' post-reading adherence to the recommended actions. For the Group A actions, pre-reading actions accounted for most of the variance in their post-reading actions.(ABSTRACT TRUNCATED AT 250 WORDS)
为提高医生对推荐医疗标准的依从性，并探究可能导致此类变化的因素，我们开展了一项随机对照试验，使用针对特定实践建议的阅读材料。79名内科住院医师完成了基线调查问卷，表明他们遵循13项常见预防保健措施的意向。他们被随机分配接受涵盖这些保健措施的两组不同阅读材料中的一组。因此，每位医生对于一组阅读材料（A或B）而言属于实验组，而对于另一组阅读材料则作为对照组。阅读材料的影响由以下因素决定：医生对综合阅读材料中详细推荐的保健措施的了解、他们阅读后的意向，以及面对有推荐措施适应症的患者时的临床行为。阅读了材料的73名住院医师（92%）认为39%的信息是新的，72%是有用的。在基于自身阅读材料的知识问题上，两组阅读材料的住院医师的表现均显著优于其对照组同行。对于A组医生，阅读显著（P小于0.05）增加了遵循七项临床措施之一的意向，而B组住院医师在六项措施中的三项上增加了意向。逐步多元回归分析用于预测医生阅读后对推荐措施的依从性。对于A组措施，阅读前的措施占其阅读后措施中大部分的方差。（摘要截选至250词）
