同行比较和教育干预对医学测试对话质量的影响:一项随机临床试验
Ishani Ganguli1,2, Kathleen L Mulligan3, Emma D Chant4
1Harvard Medical School, Boston, Massachusetts.
JAMA network open
|November 9, 2023
概括
同行比较和教育干预并没有改善医生和患者在年度访问期间的医学测试对话. 未来的努力应解决医生采用障碍,并加强患者和临床医生的关系,以减少测试的过度使用.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学教育 医学教育
- 患者沟通 患者沟通
背景情况:
- 过度使用医疗测试导致医疗保健成本增加,并通过护理级联对患者造成潜在伤害.
- 患者与临床医生的沟通不足是导致不必要的医疗检测的一个重要因素.
- 启动例行,高质量的医学测试对话是缓解这些问题的潜在策略.
研究的目的:
- 为了评估医生和患者联合教育干预的有效性,使用同行比较来提高医疗测试对话在年度访问期间.
- 评估干预对共享决策,患者知识和测试讨论的发生的影响.
主要方法:
- 进行了一项随机临床试验,涉及20名初级保健医生 (PCP) 及其在学术医疗中心的患者.
- 干预组收到了预测电子邮件,包括同行测试率比较和教育指导,以及患者教育材料.
- 对照组接受了一般预测准备提示. 使用共享决策过程 (SDMP) 调查,知识测试和测试对话分析来衡量结果.
主要成果:
- 在干预组和对照组之间的SDMP分数或医学测试知识中没有观察到统计学上显著的差异.
- 虽然两组患者中的大多数人与医生讨论了至少一个测试,但干预措施并没有改善这些对话的质量或频率.
- 医生采访显示了混合的反应,有些人发现干预有帮助,而其他人则引用了竞争的要求;大多数患者对医生的建议表示信任.
结论:
- 被测试的同行比较和教育干预并没有显著改善年度访问期间医疗测试对话的质量.
- 研究结果表明,旨在减少测试过度使用和护理级联的干预措施需要更好地应对医生采用挑战.
- 利用已建立的患者-临床医生关系可能对未来干预措施的有效性至关重要.
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