单一卫生系统RCT解决皮质类固醇注射使用在治疗成年人的ARTIs
Evan L Dvorin1, Mariella Gastanaduy2, Marissa Scott2,3
1Primary Care and Wellness, Ochsner Health, New Orleans, LA, USA. edvorin@ochsner.org.
Journal of general internal medicine
|October 30, 2025
概括
在线课程和月度报告在门诊临床医生中显著减少了近50%的急性呼吸道疾病 (ARTI) 不适当的皮质类固醇使用. 这种干预改善了ARTI护理的质量.
科学领域:
- 主要护理医学 医疗保健
- 临床实施科学 临床实施科学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 系统性皮质类固醇经常被不适当地用于急性呼吸道疾病 (ARTI),尽管有证据表明有效性有限和潜在风险.
- 不适当的皮质类固醇处方率高,导致患者的治疗结果低于最佳,医疗费用增加.
研究的目的:
- 开发和评估旨在减少门诊临床医生不适当使用皮质类固醇治疗ARTI患者的干预措施.
- 评估多方面的干预措施的有效性,包括在线教育和对临床医生处方模式的个性化反.
主要方法:
- 在路易斯安那州东南部的门诊初级保健诊所进行了一项随机对照试验.
- 治疗ARTI成年人的使用大量类固醇的临床医生被随机分配到干预或对照组.
- 干预组接受了自愿的在线课程和每月个性化关于他们使用类固醇的报告,结果在六个月内使用负二项回归评估结果.
主要成果:
- 与对照临床医生相比,该干预导致干预临床医生中皮质类固醇注射率显著下降 (每100名患者中5.5 vs 10.7).
- 这种减少意味着干预组中不适当使用皮质类固醇的比例减少了近50%.
- 该研究包括对照组的61名临床医生和干预组的75名临床医生,基线不适当的类固醇注射率与基线不适当的类固醇注射率相似 (15-16%).
结论:
- 实施的干预措施表明,对ARTTI的不适当的皮质类固醇处方的临床和统计学显著减少.
- 这项研究为确定不适当的皮质类固醇使用作为初级保健和ARTI管理中的质量指标提供了基础.
- 这些发现支持采用有针对性的教育和反策略,以改善门诊机构的处方实践.
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