Schwartzberg J G, Guttman R
Department of Geriatric Health, American Medical Association, Chicago, Ill 60610, USA.
Arch Fam Med. 1997 Sep-Oct;6(5):439-44. doi: 10.1001/archfami.6.5.439.
To evaluate the effectiveness of continuing medical education seminars in changing physician attitudes and practice approaches to the provision of home health care and use of community resources, to increase physician awareness of the needs of homebound older adults, and to teach physicians appropriate medical management in the home.
A quasi-experimental pretest and multiple posttest design.
Twenty-six seminars were conducted at medical and specialty society annual meetings in 10 states selected for their high proportion of elderly and minority populations.
Experimental subjects were a convenience sample of 355 primary care physicians who attended the seminars for which continuing medical education credits were granted. The control subjects were a proportional sample of 249 primary care physicians randomly selected from the American Medical Association Physician Masterfile matched for age, sex, locus of training (United States or abroad), and specialty.
A half-day interactive seminar. Participants were given a packet of printed materials that reinforced subject matter presented during the seminar. Core faculty for each state consisted of 2 physicians, a home health nurse, and a case manager who was familiar with community resources; physician faculty were identified by peers as local opinion leaders. All participated in a "train-the-trainer" workshop held at the American Medical Association, Chicago, Ill. Questionnaires were administered to the experimental group before the start of the seminar, immediately following the seminar, and 3 months later. The control group completed baseline and follow-up questionnaires but did not attend the seminars.
Change in physician attitudes toward providing geriatric home care, the degree to which physicians made accommodations in office practices to better manage care of patients at home, and physician willingness to use community resources.
Compared with preseminar attitudes, participants reported a change in feelings of adequacy to provide home care, as well as changes in office practice, number of home visits, and referrals to community agencies (P=.001). Before and after the seminars, US-educated male physicians were more likely to make home visits than female physicians or international medical graduates. At the 3-month follow-up, male international medical graduates were similar to US-trained male physicians. Regardless of sex or locus of training, having a high proportion (>50%) of Medicaid or minority patients or both is inversely associated with willingness to make home visits.
The seminars achieved the intended outcomes of bridging the gap in the awareness and provision of geriatric home health care and of producing physician attitude and behavior change.
评估继续医学教育研讨会在改变医生对提供家庭医疗保健及利用社区资源的态度和实践方法方面的有效性，提高医生对居家老年人需求的认识，并教授医生在家中进行适当医疗管理的方法。
一种准实验性的预测试和多次后测试设计。
在10个州的医学和专业学会年会上举办了26场研讨会，这些州因老年人口和少数族裔人口比例高而被选中。
实验对象是355名初级保健医生的便利样本，他们参加了可获得继续医学教育学分的研讨会。对照对象是从美国医学协会医生主档案中随机抽取的249名初级保健医生的比例样本，在年龄、性别、培训地点（美国或国外）和专业方面进行了匹配。
一场为期半天的互动研讨会。为参与者提供了一包印刷材料，以强化研讨会上介绍的主题内容。每个州的核心教员包括2名医生、1名家庭健康护士和1名熟悉社区资源的病例管理员；医生教员由同行认定为当地意见领袖。所有人都参加了在伊利诺伊州芝加哥市美国医学协会举办的“培训培训师”工作坊。在研讨会开始前、研讨会结束后立即以及3个月后，对实验组进行问卷调查。对照组完成了基线和随访问卷调查，但未参加研讨会。
医生对提供老年家庭护理态度的变化、医生在办公室实践中为更好地管理居家患者护理所做调整的程度，以及医生使用社区资源的意愿。
与研讨会前的态度相比，参与者报告在提供家庭护理的充足感方面有所变化，以及在办公室实践、家访次数和转介到社区机构方面也有变化（P = 0.001）。在研讨会前后，在美国接受教育的男性医生比女性医生或国际医学毕业生更有可能进行家访。在3个月的随访中，男性国际医学毕业生与在美国接受培训的男性医生情况相似。无论性别或培训地点如何，拥有高比例（>50%）的医疗补助患者或少数族裔患者或两者兼而有之与进行家访的意愿呈负相关。
这些研讨会达到了预期效果，弥合了老年家庭医疗保健意识和提供方面的差距，并使医生的态度和行为发生了改变。
