Teaching dietary counseling skills to residents: Patient and physician outcomes
Teaching dietary counseling skills to residents: Patient and physician outcomes
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DOI：
10.1016/s0749-3797(18)30322-2
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发表时间：
1996-07-01
影响因子：
5.5
通讯作者：
Fletcher, SW
中科院分区：
文献类型：
--
作者：
Evans, AT;Rogers, LQ;Fletcher, SW
我们的目的是确定对医生的教育干预和促使干预是否改善了高血液胆固醇患者的饮食咨询，并导致患者饮食和胆固醇水平的有益变化。我们进行了阶乘设计，多中心，随机，安慰剂对照试验，以测试两种干预措施。我们在美国北部和东部的七个社区和大学医学中心的内科居民的连续性护理诊所测试了该试验。我们的参与者是130名内科居民和254名成人门诊患者，血液胆固醇水平为240-300 mg/dl。干预措施包括针对旨在提高其饮食咨询技能和信心的居民医生的教育计划（两次一小时的课程，配有专门准备的印刷材料以用于咨询中）和促使干预措施，这是患者的指尖血液胆固醇的确定。诊所参观。在干预之前，使用图表审核和问卷调查了常驻医师的知识，态度和自我报告的行为。还通过与患者的退出访谈评估居民的行为。在基线和10个月后，测量了患者的知识，态度，行为和指尖血液胆固醇水平。教育计划增加了有信心提供有效饮食咨询的医师的百分比（基线为26％至67％-78％； p <.01）。促使干预措施大约使医师咨询的频率翻了一番（P = .0005），并增加了患者试图改变饮食的可能性。当两种干预措施合并时，大多数结果都更好，尽管没有统计学意义。然而，胆固醇水平仅略有下降，在10个月的随访中，组之间的胆固醇水平也没有什么不同。尽管在改变医生的态度和行为以及增加患者改变饮食的意愿方面取得了成功，但患者的胆固醇水平没有显着变化。
Our objective was to determine whether an educational intervention and prompting intervention for physicians improved dietary counseling of patients with high blood cholesterol and resulted in beneficial changes in patients' diets and cholesterol levels. We instituted a factorial design, multicenter, randomized, placebo-controlled trial to test two interventions. We tested the trial at continuity care clinics of internal medicine residents at seven community and university medical centers in the northern and eastern United States. Our participants were 130 internal medicine residents and 254 adult outpatients with blood cholesterol levels of 240-300 mg/dL. Interventions included an educational program for resident physicians designed to improve their skills and confidence in dietary counseling (two one-hour sessions with specially prepared printed materials for use in counseling) and a prompting intervention, which was a fingerstick blood cholesterol determination prior to the patient's clinic visit. Resident physicians' knowledge, attitudes, and self-reported behaviors were assessed prior to the intervention and 10 months later using chart audits and questionnaires. Residents' behaviors were also assessed by exit interviews with patients. Patients' knowledge, attitudes, behaviors, and fingerstick blood cholesterol levels were measured at baseline and 10 months later. The educational program increased the percentage of physicians who were confident in providing effective dietary counseling (baseline of 26% to 67%-78%; P < .01). The prompting intervention approximately doubled the frequency of physician counseling (P = .0005) and increased the likelihood that patients would try to change their diets. When both interventions were combined, most outcomes were better, although not statistically significant. Cholesterol levels, however, decreased only marginally and were no different among groups at 10-month follow-up. Despite success in changing physicians' attitudes and behaviors and increasing patients' willingness to change their diets, there was no significant change in patients' cholesterol levels.