行为干预对初级保健实践中不适当的抗生素处方的影响:随机临床试验
Daniella Meeker1, Jeffrey A Linder2, Craig R Fox3
1Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles2RAND Corporation, Santa Monica, California.
JAMA
|February 12, 2016
概括
行为干预,如负责任的证明和同行比较,大大减少了对急性呼吸道感染的不适当的抗生素处方. 这些策略为改善抗生素管理提供了有效的方法.
科学领域:
- 行为科学
- 传染病管理
- 主要护理医学
背景情况:
- 对急性呼吸道感染 (ARTIs) 进行不适当的抗生素处方仍然是一个重大的公共卫生问题.
- 行为科学原则为改变临床医生的处方习惯提供了潜在的策略.
研究的目的:
- 评估行为干预措施在 ambulatory care 环境中减少不适当的抗生素处方的有效性.
- 评估具体干预措施的影响:建议的替代方案,负责任的理由和同行比较.
主要方法:
- 一个集群随机临床试验,涉及47个初级保健实践和248名临床医生.
- 在18个月内,临床医生被随机分配为0,1,2或3次行为干预.
- 收集关于ARTIs抗生素处方率的数据,并根据同时发生的干预措施和干预前趋势进行分析调整.
主要成果:
- 有责任的理由和同行比较干预措施显著降低了不适当的抗生素处方率.
- 有责任的证明干预结果显示差异差异为 -7.0% (P < .001).
- 同行比较干预结果显示差异为 - 5. 2% (P < . 001).
结论:
- 行为干预,特别是负责任的理由和同行比较, 有效地减少了不适当的抗生素处方对ARTIs.
- 这些发现支持将行为策略整合到电子健康记录和实践级反中,以加强抗生素管理.
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