Schectman J M, Kanwal N K, Schroth W S, Elinsky E G
Department of Health Care Sciences, George Washington University Medical Center, Washington, DC 20037.
Med Care. 1995 Feb;33(2):139-44.
The authors evaluated the effect of an educational and feedback intervention on H2-blocker prescribing patterns and determined, if such effects differed for network- versus group-model health maintenance organization (HMO) physicians and in academic versus nonacademic settings. Physicians were randomized to receive an educational memorandum alone or combined with feedback regarding their individual prescribing behavior. The memo suggested preferred use of an H2-blocker (cimetidine) that would be less expensive to the HMO. Prescribing was monitored during the 6 months before and after the intervention. The study was undertaken at the primary care practices of a mixed group- and network-model university-affiliated HMO. Thirty group-model (at two academic and four nonacademic sites) and 33 network-model (all in full-time private practice) primary care physicians participated in the study. The analysis utilized weighted and unweighted analysis of covariance of the change in physicians' cimetidine-prescribing rates between the baseline and study periods. A significant response to the intervention was noted among academic and nonacademic group-model HMO physicians, but not among network physicians (adjusted mean absolute prescribing changes of +9.9% and +8.9% versus -2.8%, P = .02). There was no difference in prescribing change based on type of intervention (education versus feedback). The authors conclude that a simple passive educational intervention can be effective at changing group-model HMO physician behavior.
作者评估了一项教育与反馈干预措施对H2受体阻滞剂处方模式的影响，并确定这种影响在网络型与团体模式健康维护组织（HMO）的医生之间以及学术环境与非学术环境中是否存在差异。医生被随机分组，分别单独接受一份教育备忘录，或同时接受关于其个人处方行为的反馈。该备忘录建议优先使用一种对HMO成本更低的H2受体阻滞剂（西咪替丁）。在干预前后的6个月内对处方情况进行监测。该研究在一所大学附属的团体与网络混合模式HMO的初级保健机构中进行。30名团体模式（在两个学术机构和四个非学术机构）和33名网络模式（均为全职私人执业）的初级保健医生参与了研究。分析采用了对医生在基线期和研究期之间西咪替丁处方率变化的加权和非加权协方差分析。学术和非学术团体模式HMO的医生对干预有显著反应，但网络模式的医生没有（调整后的平均绝对处方变化分别为+9.9%和+8.9%，而网络模式为-2.8%，P = .02）。基于干预类型（教育与反馈）的处方变化没有差异。作者得出结论，简单的被动教育干预可以有效地改变团体模式HMO医生的行为。
