Dietrich A J, Sox C H, Carney P A, Winchell C W, Brown-McKinney N
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755-3833, USA.
Acad Med. 1997 May;72(5):391-3. doi: 10.1097/00001888-199705000-00021.
To determine the proportion of regional primary care physicians who would attend grand rounds on preventive services and their interest in and use of free follow-up enabling and reinforcing assistance to implement changes in their practice routines.
From January to July 1992 grand rounds on early detection of cancer were offered by Dartmouth Medical School at 38 acute care community hospitals in New Hampshire and Vermont. The target audience of 679 family physicians and general internists was identified through state medical society and hospital attending lists. The hour-long grand rounds program described preventive service guidelines and an office system that promoted their implementation. Follow-up practice support with planning, office staff training, and materials were offered to augment the effects of the grand rounds. Attendance was determined by sign-in documents. In addition, all attendees were asked to complete a survey regarding practice and personal characteristics and interest in follow-up assistance. Statistical comparisons were made using chi square and Fisher's exact tests.
In all, 261 family medicine physicians and general internists (38.4%) attended. Certain categories of physicians were more likely to have attended: internists, those younger than 55 years, and physicians on the staffs of hospitals located in small towns. Assistance was requested by 70.1% of the attendees; many requested more than one type of assistance. Physicians from hospitals in smaller towns were more likely to show interest in follow-up assistance and use it when offered.
Many of the grand rounds attendees were receptive to follow-up assistance that could improve the preventive services they provided. Most hospitals offer grand rounds, and many organizations have interest in and resources for helping physicians provide high-quality care. Future research should establish the best linkage to the actual care provided in practices and explore the relevance of similar approaches to clinical areas beyond prevention.
确定愿意参加预防服务大查房的地区初级保健医生的比例，以及他们对免费后续支持与强化协助以改变其日常诊疗习惯的兴趣和使用情况。
1992年1月至7月，达特茅斯医学院在新罕布什尔州和佛蒙特州的38家急症社区医院举办了癌症早期检测大查房。通过州医学协会和医院出诊名单确定了679名家庭医生和普通内科医生作为目标受众。为期一小时的大查房项目介绍了预防服务指南以及促进其实施的办公系统。提供了包括规划、办公室工作人员培训和资料在内的后续实践支持，以增强大查房的效果。通过签到文件确定出勤情况。此外，所有参会者都被要求完成一项关于诊疗习惯、个人特征以及对后续协助兴趣的调查。使用卡方检验和费舍尔精确检验进行统计比较。
共有261名家庭医学医生和普通内科医生（38.4%）参加。某些类别的医生更有可能参加：内科医生、年龄小于55岁的医生以及来自小镇医院的医生。70.1%的参会者请求提供协助；许多人请求不止一种类型的协助。来自较小城镇医院的医生更有可能对后续协助表现出兴趣并在有机会时加以使用。
许多参加大查房的医生愿意接受能够改善其提供的预防服务的后续协助。大多数医院都提供大查房，而且许多组织有兴趣并有资源帮助医生提供高质量的医疗服务。未来的研究应确定与实际诊疗中提供的护理的最佳联系，并探索类似方法在预防以外的临床领域的相关性。
