Ockene J K, Ockene I S, Quirk M E, Hebert J R, Saperia G M, Luippold R S, Merriam P A, Ellis S
Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Prev Med. 1995 Nov;24(6):563-70. doi: 10.1006/pmed.1995.1090.
We examined the effect of a 3-hr training program on physicians' lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered counseling to enable patients with elevated lipids to change their dietary patterns.
The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported nutrition intervention practices, and counseling and assessment skills. Physicians also rated the value that they thought the training program had to them.
After completion of the program the physicians' use of dietary counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased (mean pre = 5.4, mean post = 9.2; t = 9.9; P < or = 0.001). In this regard, there were instances in the use of 7 of the 14 specific counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale (mean pre = 3.2, mean post = 4.0; t = 4.25; P < 0.001), confidence in having an effect (mean pre = 3.3, mean post = 3.9; t = 3.16; P < 0.01), perception that materials were available to aid intervention (mean pre = 2.7, mean post = 4.0; t = 5.29; P < 0.001), and perception that they have access to a nutritionist (mean pre = 3.5, mean post = 4.0; t = 2.63; P < 0.01). They rated the value of the program between very good and excellent.
Results of this 3-hr educational program indicate that physicians in an HMO are responsive to the teaching of specialized skills deemed important for promoting health behavior change in their patients.
我们研究了一项为期3小时的培训项目对医生血脂干预知识、态度和技能的影响。该项目教授医生进行简短饮食风险评估的技能，并提供以患者为中心的咨询，以使血脂升高的患者改变其饮食模式。
该培训是降脂干预随机试验（伍斯特地区高脂血症咨询试验）的一部分。对在健康维护组织（HMO）执业的初级保健内科医生在培训前后进行评估，使用问卷和录音带记录饮食知识、干预态度、报告的营养干预实践以及咨询和评估技能的变化。医生还对他们认为培训项目对自己的价值进行了评分。
项目完成后，通过对医生与患者互动录音带的盲法评估，医生饮食咨询步骤的使用显著增加（术前平均 = 5.4，术后平均 = 9.2；t = 9.9；P≤0.001）。在这方面，14个具体咨询步骤中有7个步骤的使用出现了这种情况。医生自我感知的准备程度也有所提高，通过5分制衡量（术前平均 = 3.2，术后平均 = 4.0；t = 4.25；P < 0.001），对产生效果的信心（术前平均 = 3.3，术后平均 = 3.9；t = 3.16；P < 0.01），认为有辅助干预的材料（术前平均 = 2.7，术后平均 = 4.0；t = 5.29；P < 0.001），以及认为能够获得营养师帮助（术前平均 = 3.5，术后平均 = 4.0；t = 2.63；P < 0.01）。他们对该项目的价值评价为非常好到优秀之间。
这个3小时教育项目的结果表明，HMO中的医生对被认为对促进患者健康行为改变很重要的专业技能教学有反应。
