Epstein S A, Gonzales J J, Onge J S, Carter-Campbell J, Weinfurt K, Leibole M, Goldberg R L
Department of Psychiatry, Georgetown University Medical Center, Washington, D.C. 20007, USA.
Psychosomatics. 1996 Jul-Aug;37(4):356-67. doi: 10.1016/S0033-3182(96)71549-9.
By use of a survey that assessed practice patterns and responses to case vignettes of anxiety and depression in the medically ill, 38 psychiatrists were compared with 10 national leaders in consultation-liaison psychiatry. On the case vignettes, percentage agreement with the experts varied significantly by case and by question. Fifty-eight percent of the time the psychiatrists agreed with the experts on whether to order laboratory tests as compared with an 81% agreement level on whether to use psychotherapy. Multiple regression analysis revealed that the best model to predict lower agreement with the experts was years in practice plus percentage of time spent in solo (vs. group) practice (r2 = 0.40). This study extended previous data-based pharmacoepidemiology by assessing multiple aspects of psychiatrists' practice patterns. Psychiatrists who are more distant from training years and more isolated from the current stimulation of colleagues may be particularly appropriate targets for continuing education.
通过一项评估内科疾病患者焦虑和抑郁的实践模式及对病例 vignettes 反应的调查，将 38 名精神科医生与 10 名全国会诊 - 联络精神病学领域的领导者进行了比较。在病例 vignettes 方面，精神科医生与专家的百分比一致性因病例和问题而异。在是否进行实验室检查方面，精神科医生有 58% 的时间与专家意见一致，而在是否采用心理治疗方面，这一一致率为 81%。多元回归分析显示，预测与专家较低一致性的最佳模型是从业年限加上独自（而非团队）执业的时间百分比（r2 = 0.40）。这项研究通过评估精神科医生实践模式的多个方面，扩展了先前基于数据的药物流行病学。那些距离培训年限较远且与同事当前的激励较为隔绝的精神科医生可能是继续教育的特别合适目标。
