Guiscafre H, Martínez H, Reyes H, Pérez-Cuevas R, Castro R, Muñoz O, Gutiérrez G
Grupo Interinstitucional de Investigación en Sistemas de Salud, Instituto Mexicano del Seguro Social-Secretaría de Salud, México, D.F.
Arch Med Res. 1995;26 Spec No:S31-9.
Errors in treating common diseases occur very frequently in primary health care practice. While many of these mistakes are not life-threatening, the costs of abuse in drug prescription may be greatly increased. An educational strategy aimed to improve physicians' prescribing practices for acute diarrhea (AD) and acute respiratory infection (ARI) was developed as a research study, involving three medical care units. The strategy was largely based on promoting active participation of the trainees in the whole process, including: (a) group participation in a literature review of updated articles related to management of AD and ARI; (b) analysis of prescribing practices before the intervention; (c) participation in the development of a clinical algorithm for the therapeutic management of these illnesses; and (d) discussion of the usefulness of the algorithm during peer review committee meetings. Successful results of this intervention, as judged by the improvement of treatment practices and the persistence of changes for up to 2 years after the intervention, as well as its ease of application and low costs, motivated its extension to a health District and a State. In these sites, the intervention was in charge of medical leaders from the clinics and medical heads of the local health systems, respectively. The extension of the educational strategy was accompanied by a relative reduction in AD from 46.7% to 6.5% and in ARI from 32.6% to 8.5%. However, the benefit-cost ratio showed a dramatic increase when comparing results from the research study and from the State intervention, for both AD (from 3.3 to 4.4) and ARI (from 16.2 to 21.6), for an overall net increase of 33.3%. Based on these results, the educational strategy was adopted by the National Program for the Control of Diarrheal Diseases, and was used to train public health physicians throughout the country, from 1992 to 1994.
在初级卫生保健实践中，常见疾病的治疗错误非常频繁。虽然其中许多错误不会危及生命，但药物处方滥用的成本可能会大幅增加。作为一项研究，制定了一项旨在改善医生对急性腹泻（AD）和急性呼吸道感染（ARI）的处方做法的教育策略，该研究涉及三个医疗单位。该策略主要基于促进学员积极参与整个过程，包括：（a）小组参与对与AD和ARI管理相关的最新文章的文献综述；（b）干预前对处方做法的分析；（c）参与制定这些疾病治疗管理的临床算法；以及（d）在同行评审委员会会议上讨论该算法的实用性。根据治疗做法的改善以及干预后长达两年的变化持续性，以及其易于应用和低成本来判断，该干预取得了成功结果，这促使其扩展到一个卫生区和一个州。在这些地点，干预分别由诊所的医疗领导人和当地卫生系统的医疗主管负责。教育策略的扩展伴随着AD从46.7%相对降至6.5%，ARI从32.6%相对降至8.5%。然而，与研究和州干预的结果相比，AD（从3.3增至4.4）和ARI（从16.2增至21.6）的效益成本比大幅增加，总体净增33.3%。基于这些结果，腹泻病控制国家计划采用了该教育策略，并在1992年至1994年期间用于培训全国的公共卫生医生。
