Rabin D L, Boekeloo B O, Marx E S, Bowman M A, Russell N K, Willis A G
Georgetown University School of Medicine, Washington, D.C.
Ann Intern Med. 1994 Oct 1;121(7):513-9. doi: 10.7326/0003-4819-121-7-199410010-00007.
To determine whether office-based interventions increase primary care physicians' risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV).
Randomized controlled clinical trial.
Washington, D.C., Metropolitan Statistical Area.
Office-based primary care physicians (family or general practice, internal medicine, and obstetrics-gynecology).
Mailed educational materials alone or coupled with a simulated patient instructor office visit.
Self-reported and observed frequency of assessing and counseling patients regarding their risk factors for sexually transmitted diseases and HIV infection. Participants were interviewed by telephone before and after the intervention (n = 757). A subset of participants (n = 194) was also observed after the intervention by simulated patient evaluators in blinded office visits.
89% of physicians who received both educational materials and a simulated patient instructor visit reported that they reviewed the educational materials compared with 53% of those who only received the educational materials (P < or = 0.001). Physicians in the combined intervention group had higher self-reported and observed rates for several risk assessment questions and counseling recommendations than did physicians in the control group or the group that only received educational materials. Seventy-three percent of physicians of the combined intervention group reported an increase in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P < or = 0.001).
Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians' risk assessment and risk reduction counseling of patients for sexually transmitted diseases and HIV infection.
确定以办公室为基础的干预措施是否能提高基层医疗医生对患者性传播疾病和人类免疫缺陷病毒（HIV）的风险评估及咨询实践。
随机对照临床试验。
华盛顿特区大都市统计区。
以办公室为基础的基层医疗医生（家庭或全科、内科和妇产科）。
单独邮寄教育材料或与模拟患者指导教师办公室访视相结合。
自我报告和观察到的评估患者性传播疾病和HIV感染风险因素并提供咨询的频率。在干预前后通过电话对参与者进行访谈（n = 757）。干预后还通过模拟患者评估人员在不知情的办公室访视中对一部分参与者（n = 194）进行了观察。
同时收到教育材料和模拟患者指导教师访视的医生中，89%报告他们查看了教育材料，而仅收到教育材料的医生中这一比例为53%（P≤0.001）。综合干预组的医生在几个风险评估问题和咨询建议方面的自我报告率和观察到的比率高于对照组或仅收到教育材料的组。综合干预组73%的医生报告称，在为患者提供减少危险性行为的咨询方面有所增加，相比之下，仅收到教育材料的组为53%，对照组为42%（P≤0.001）。
邮寄教育材料并结合模拟患者指导教师的办公室访视进行角色扮演和临床绩效反馈，增加了基层医疗医生对患者性传播疾病和HIV感染的风险评估及降低风险咨询的频率。
