Schaffner W, Ray W A, Federspiel C F, Miller W O
JAMA. 1983 Oct 7;250(13):1728-32.
We conducted a statewide controlled trial of three methods to improve antibiotic prescribing in office practice: a mailed brochure, a drug educator visit, and a physician visit. Educational topics were three antibiotics contraindicated for office practice and oral cephalosporins. Medicaid prescribing data were used to select donors who needed education. The effect of the methods was evaluated by comparing the change in prescribing (the year before the intervention v the year after the intervention) for the doctors receiving education with the prescribing of comparable doctors chosen as controls. The mailed brochure had no detectable effect, and the drug educator had only a modest effect. The physician visits produced strong attributable reductions in prescribing of both drug classes. For the contraindicated antibiotics, the reductions were 18% in number of doctors prescribing, 44% in number of patients per doctor receiving these drugs, and 54% in number of prescriptions written per doctor. For the oral cephalosporins, both number of patients and number of prescriptions per doctor were reduced by 21%. Doctors responded equally well to recommendations designed to improve the quality of care and to reduce the cost of care.
我们在全州范围内开展了一项对照试验，以评估三种改善门诊抗生素处方行为的方法：邮寄宣传册、药物教育工作者上门指导以及医生上门指导。教育主题包括门诊禁用的三种抗生素以及口服头孢菌素。我们利用医疗补助计划的处方数据来挑选需要接受教育的对象。通过比较接受教育的医生在干预前一年与干预后一年的处方变化，以及作为对照的可比医生的处方情况，来评估这些方法的效果。邮寄宣传册未产生明显效果，药物教育工作者上门指导的效果也很有限。医生上门指导使得两类药物的处方量显著减少。对于禁用抗生素，开具此类药物的医生数量减少了18%，每位开具此类药物的医生的患者数量减少了44%，每位医生开具的处方数量减少了54%。对于口服头孢菌素，每位医生的患者数量和处方数量均减少了21%。医生对旨在提高医疗质量和降低医疗成本的建议反应良好。
