Bush P J, Rabin D L, Spector K K
Med Care. 1979 Jun;17(6):566-77. doi: 10.1097/00005650-197906000-00002.
Effective means of affecting physician prescribing behavior must be developed if the quality of health care is to be improved. A drug therapy protocol for otitis media, containing a rationale for drugs, doses and days of therapy by patient age, was developed by a physician panel at one site (EI) of an HMO, and implemented at both EI and a second site (EII); a third site was a control. A comparison of prescribing during two phases, before and after implementation of the protocol, suggested that the protocol had a greater influence at site EI than site EII, and that it had a greater influence on the panel physicians than on other prescribers at site EI. Questionnaire responses indicated that clinical experience and personal involvement were the most important protocol use influences. If participation is critical to protocol compliance, the protocol method to improve the quality of health care is severely limited.
如果要提高医疗保健质量，就必须开发出影响医生开处方行为的有效方法。某健康维护组织（HMO）的一个站点（EI）的医生小组制定了一份中耳炎药物治疗方案，其中包含用药依据、根据患者年龄确定的剂量和疗程，并在EI和第二个站点（EII）实施；第三个站点作为对照。对该方案实施前后两个阶段的处方情况进行比较，结果表明该方案对EI站点的影响大于EII站点，且对EI站点的小组医生的影响大于对其他开处方者的影响。问卷调查结果显示，临床经验和个人参与是影响方案使用的最重要因素。如果参与对方案的依从性至关重要，那么通过方案来提高医疗保健质量的方法将受到严重限制。
