Overhage J M, Tierney W M, McDonald C J
Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Arch Intern Med. 1996 Jul 22;156(14):1551-6.
Hospitalizations are an opportunity to provide preventive care.
To determine if computer reminders, which we have shown to be effective in our ambulatory care setting, increasing the provision of inpatient preventive care.
Randomized, controlled trial on the general medicine inpatient service of an urban, university-affiliated public hospital. Study subjects were 78 house staff rotating on the 6 general medicine services. The intervention was reminders to physicians printed on daily rounds reports about preventive care for which their patients were eligible, and suggested orders for preventive care provided through the physicians' workstations. The preventive care guidelines were derived from the US Preventive Care Task Force recommendations. Compliance with preventive care guidelines and house staff attitudes toward providing preventive care to hospitalized patients were the main outcome measures.
No significant differences were seen between intervention and control physicians in compliance with preventive care guidelines in the aggregate or when individual preventive care actions individual preventive care actions were analyzed. This was true even though most physicians endorsed providing most kinds of preventive care for hospitalized patients.
Despite past success in increasing preventive care in the outpatient setting, we were unable, using a moderately intensive intervention, to increase the provision of preventive care during hospitalizations. The physicians providing care during the hospitalization were not the patients' primary care physicians, which proved to be an important barrier. More intensive interventions, or more direct linkages between inpatient and outpatient care providers, may be required to overcome this resistance.
住院治疗是提供预防性护理的一个契机。
确定计算机提醒（我们已证明其在门诊护理环境中有效）是否能增加住院患者预防性护理的提供。
在一家城市大学附属医院的普通内科住院部进行随机对照试验。研究对象是在6个普通内科科室轮转的78名住院医师。干预措施是在每日查房报告上向医生打印关于其患者符合条件的预防性护理提醒，并通过医生工作站提供预防性护理的建议医嘱。预防性护理指南源自美国预防保健工作组的建议。主要结局指标是对预防性护理指南的依从性以及住院医师对为住院患者提供预防性护理的态度。
在总体上或分析个体预防性护理行动时，干预组和对照组医生在遵守预防性护理指南方面没有显著差异。即便大多数医生认可为住院患者提供大多数类型的预防性护理，情况依然如此。
尽管过去在门诊环境中增加预防性护理方面取得了成功，但我们采用适度强化干预措施，仍无法在住院期间增加预防性护理的提供。住院期间提供护理的医生并非患者的初级保健医生，这被证明是一个重要障碍。可能需要更强化的干预措施，或者住院和门诊护理提供者之间更直接的联系，以克服这种阻力。
