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Efecto de una estrategia basada en la práctica en el rendimiento de orden de prueba de los médicos de atención

Wim H J M Verstappen¹, Trudy van der Weijden, Jildou Sijbrandij

¹Center for Quality of Care Research, Department of General Practice, Maastricht University, Maastricht, The Netherlands. wim.verstappen@hag.unimass.nl

|May 15, 2003

Resumen

Una nueva estrategia redujo las pruebas diagnósticas innecesarias ordenadas por los médicos de atención primaria. Este enfoque, utilizando pautas clínicas y retroalimentación, mostró mejoras modestas en el rendimiento de la orden de prueba.

Área de la Ciencia:

Medicina de la Atención Primaria La medicina de la atención primaria es la medicina de la atención primaria.
Servicios de salud Servicios de salud Investigación Investigación.
Práctica basada en la evidencia.

Sus antecedentes:

El creciente número de pruebas de diagnóstico ordenadas por los médicos de atención primaria (PCP) plantea preocupaciones sobre la utilización innecesaria.
Las directrices establecidas basadas en la evidencia destacan la necesidad de optimizar las prácticas de pedido de pruebas.

Objetivo del estudio:

Evaluar una estrategia multifacética diseñada para mejorar el rendimiento de orden de pruebas de los médicos de atención primaria.
Evaluar el impacto de la retroalimentación basada en directrices e interacción social en la utilización de las pruebas de diagnóstico.

Principales métodos:

Se empleó un ensayo multicéntrico, aleatorizado y controlado con un diseño de bloques equilibrado e incompleto.
Participaron veintiséis grupos de médicos de atención primaria (174 médicos) en cinco regiones de los Países Bajos.
Una intervención que involucró discusiones sobre las directrices, informes de retroalimentación personal y planificación de acciones se implementó durante seis meses.

Principales resultados:

Los médicos que recibieron la intervención mostraron una reducción significativa del 12% en las pruebas totales ordenadas para los problemas clínicos asignados (brazo A).
Se observó una reducción significativa en las pruebas inadecuadas en el brazo A, mientras que el brazo B mostró una reducción no significativa.
La intervención condujo a una reducción media de 67 pruebas más por médico durante seis meses en el brazo A en comparación con el brazo de control (P=.01).

Conclusiones:

Una estrategia multifacética basada en la práctica que incorpora pautas, retroalimentación e interacción social produjo mejoras modestas en el pedido de pruebas de los médicos de atención primaria.
Los hallazgos sugieren que las intervenciones dirigidas pueden influir positivamente en la utilización de pruebas de diagnóstico en entornos de atención primaria.

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