多种建议的护理选择和初级保健医生的决策:一项随机临床试验
Gemma Altinger1,2, Christopher G Maher1,2, Caitlin M P Jones1,2
1Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia.
JAMA network open
|November 13, 2025
概括
在临床决策支持中提供多种治疗选择,增加了医生采用首选护理的可能性. 提出两个或两个以上的选择,而不是一个,显著改善了对推治疗的坚持.
科学领域:
- 临床决策支持 临床决策支持
- 医疗信息学 医疗信息学
- 医疗决策的制定 医疗决策的制定
背景情况:
- 决策支持警报指导临床决策的首选护理.
- 提出的替代方案数量对决策质量的影响仍然不清楚.
研究的目的:
- 评估提供两个或两个以上合适的治疗替代方案与一个治疗方案对临床护理决策的影响.
主要方法:
- 一项随机临床试验,涉及402名美国初级保健医生 (PCP).
- 医生被随机分配,在两个临床情景中接受一个或多个 (2-4) 治疗替代方案.
- 主要结果是PCP选择替代管理计划的比例.
主要成果:
- 提出两个或两个以上替代方案的医生更有可能选择一种替代方案 (62.1%),而不是一个替代方案 (44.0%) (调整后的OR,1.90;P=.02).
- 这种影响在阿片类药物处方决策中比在关节骨关节炎手术转诊中更为明显.
- 提供两个以上的替代品并没有进一步增加选择替代品的可能性.
结论:
- 提出多种合适的治疗替代方案可以提高医生采用首选的护理.
- 这一发现挑战了当提供多个选项时现状偏差的概念.
- 优化决策支持警报以包括多种替代方案可能会提高医疗保健质量.
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