基于实践的策略对初级保健医生的测试订单表现的影响:一个随机试验
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
JAMA
|May 15, 2003
概括
一个新的策略减少了初级保健医生订购的不必要的诊断测试. 这种方法,使用临床指南和反,在测试订购性能方面显示出适度的改善.
科学领域:
- 主要护理医学 医疗保健
- 医疗保健服务研究 医疗服务研究
- 基于证据的实践.
背景情况:
- 越来越多的初级保健医生 (PCP) 订购的诊断测试引发了人们对不必要利用的担忧.
- 建立了基于证据的指导方针,强调需要优化测试订购实践.
研究的目的:
- 评估一项旨在提高初级保健医生测试订单表现的多方面的策略.
- 评估基于指南的反和社会互动对诊断测试利用的影响.
主要方法:
- 采用了一个多中心,随机对照试验,具有平衡的,不完整的块设计.
- 26个初级保健医生组 (174名医生) 在荷兰的五个地区参与了这项研究.
- 一项涉及指导方针讨论,个人反报告和行动计划的干预措施在六个月内实施.
主要成果:
- 接受干预的医生显示,针对分配的临床问题 (A臂) 订购的测试总数显著减少了12%.
- 在A臂观察到不适当测试的显著减少,而B臂显示非显著的减少.
- 与对照组相比,该干预措施导致A组在六个月内平均减少了每位医生67次更多的测试 (P=.01).
结论:
- 一个基于实践的,多方面的策略,包括指导方针,反和社交互动,在初级保健医生的测试订单方面取得了适度的改善.
- 这些发现表明,有针对性的干预措施可以积极影响初级保健机构的诊断测试使用情况.
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