Seneviratne S L, Gunatilake S B, Adhikari A A, Gunawardhana P, de Silva H J
Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Int J Cardiol. 1998 Dec 31;67(3):237-40. doi: 10.1016/s0167-5273(98)00312-x.
Evidence obtained from large clinical trials would be of limited value, if such evidence does not reach the provider of care, and even when it reaches them, if they do not change their clinical behaviour accordingly. The aim of our study was to assess the effectiveness of intervention, aimed at changing prescribing behaviour of general practitioners (GPs) with regard to early low dose aspirin in patients with suspected acute myocardial infarction (MI).
A total of 96 GPs were sent a questionnaire assessing their knowledge and practices with regard to use of low dose aspirin in acute MI in November 1995 (Q1), June 1996 (Q2) and September 1996 (Q3). An 'intervention' was carried out with a view to changing GP prescribing of low dose aspirin is suspected acute MI after the first two questionnaires were sent.
The results of this study seem to show that an intensive 'intervention' achieved success in changing prescribing behaviour of GPs. Although the intervention resulted in a overall significant increase in the prescription of low dose aspirin in suspected acute MI, it was seen that in the GPs who were aged <40 years the success achieved with the 'intervention' was greater when compared with that seen in those older than 40 years.
Dissemination of information on new practices in medicine are important in the process of continuing medical education for doctors. A 'personal intervention' such as is described in this study seems to have good effect.
如果从大型临床试验中获得的证据无法传达给医疗服务提供者,那么其价值将十分有限;即便证据传达给了他们,但如果他们并未因此改变临床行为,其价值同样有限。我们研究的目的是评估一项干预措施的有效性,该措施旨在改变全科医生(GP)对疑似急性心肌梗死(MI)患者早期使用低剂量阿司匹林的处方行为。
1995年11月(问卷1)、1996年6月(问卷2)和1996年9月(问卷3),共向96名全科医生发放了一份问卷,评估他们在急性心肌梗死中使用低剂量阿司匹林的知识和实践情况。在前两份问卷发放后,实施了一项“干预”措施,旨在改变全科医生对疑似急性心肌梗死患者使用低剂量阿司匹林的处方行为。
本研究结果似乎表明,强化“干预”在改变全科医生的处方行为方面取得了成功。尽管干预导致疑似急性心肌梗死患者低剂量阿司匹林的处方总体显著增加,但可以看出,年龄小于40岁的全科医生通过“干预”取得的成功比40岁以上的全科医生更大。
传播医学新实践信息在医生继续医学教育过程中很重要。本研究中描述的“个人干预”似乎效果良好。