在初级保健中不同脱离实施策略的有效性:系统审查和元分析
Aleksi Raudasoja1,2, Sameer Parpia3,4, Jussi M J Mustonen5
1Finnish Medical Society Duodecim, Helsinki, Finland.
BMJ medicine
|September 12, 2025
概括
提供者教育与审计和反相结合,有效地减少了初级保健中的低价值护理. 可能需要多种策略,以显著影响减少不必要的治疗和测试.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 基于证据的医学基于证据的医学.
- 初级保健干预措施 初级保健干预措施
背景情况:
- 低价值护理,定义为提供最小患者益处的治疗或测试,有助于医疗保健成本和潜在危害.
- 退出实施策略旨在减少在临床实践中使用这种低价值护理.
- 初级保健机构对于实施改变以减少不必要的医疗干预至关重要.
研究的目的:
- 在初级保健中系统地审查和元分析退出实施干预措施的有效性.
- 评估旨在减少低价值护理 (治疗或测试) 的策略.
主要方法:
- 随机试验的系统审查和元分析.
- 搜索了Medline和Scopus数据库,直到2024年7月.
- 使用GRADE方法评估偏差风险和证据确定性.
主要成果:
- 包括140项试验,随访时间中位数为287天.
- 与审计和反相结合的提供者教育显示,减少低价值护理的证据具有中等的确定性 (OR 0.73).
- 提供者教育,审计和反以及患者教育等个别策略显示出潜力,但证据确定性较低.
结论:
- 提供者教育与审计和反相结合,是消除初级保健中的实施的一个有希望的策略.
- 为了大幅减少低价值护理,可能需要整合多种退出实施策略.
- 调查结果可以为患者,临床医生,政策制定者和指导方针制定者提供有关未来撤销实施努力的信息.
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