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監査とフィードバック,およびリマインダーメッセージが,プライマリーケア放射線学の紹介に与える影響:ランダム化試験
M Eccles1, N Steen, J Grimshaw
1Centre for Health Services Research, University of Newcastle upon Tyne, NE2 4AA, Newcastle upon Tyne, UK. martin.eccles@ncl.ac.uk
Lancet (London, England)
|May 18, 2001
まとめ
教育的なリマインダーメッセージは,腰椎と膝のX線写真に対する全科医の要求を約20%削減しました. 監査とフィードバックの方法は,放射線検査の使用の削減に最小限の影響を及ぼしました.
科学分野:
- 医療サービス 研究 医療サービス
- 臨床放射線学 臨床放射線学
- 一般的実践について
背景:
- 一般医師は,放射線検査を頻繁に利用しており,過剰使用が臨床管理に影響を与える可能性があります.
- イギリスのロイヤル・カレッジ・オブ・ラジオロジストのガイドラインは,腰椎と膝のX線写真の使用を最適化することを目的としています.
研究 の 目的:
- 2つの介入―監査とフィードバック,および教育的なリマインダーメッセージ―が,放射線検査のGPの要求を削減する効果を評価する.
- 腰椎と膝のX線写真に関するガイドラインの遵守を評価する.
主な方法:
- 232の因数式設計によるプラグマティックなクラスターランダム化対照試験は,6つの放射線科と244の総合診療所で実施されました.
- 介入には,監査とフィードバック,そしてX線写真に添付された教育的なリマインダーメッセージが含まれていました.
- 年間1000人の患者に当たりの放射線検査の要求率は,介入前と後に測定され,治療の意図分析が行われました.
主要な成果:
- 教育的なリマインダーメッセージは,腰椎と膝のX線写真要求の有意な減少につながり,絶対的な変化は,それぞれ1000人の患者当たり-1.53と-1.61でした (約1.61). 20%の相対的な減少).
- 監査とフィードバックは最小限の効果を示し,腰椎の絶対的な変化は -0.07,膝のX線写真の絶対的な変化は -0.04 (約0.07) であった. 1%の相対的な減少).
- グループ間では,推薦の質やガイドラインとの一致性において有意な差は認められなかった.
結論:
- 定期的な教育的なリマインダーメッセージは,推薦の質を損なうことなく,腰椎と膝のX線写真に対するGPの要求を減らすのに有効です.
- 6ヶ月の監査データフィードバックは,X線写真のリクエスト率を減らすのに無効であることが判明しました.
- 放射線科は,初等医療から放射線検査の適切な使用を改善するために,教育的なリマインダーメッセージを実装することができます.
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