Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors' attitudes, knowledge and clinical behaviour: a controlled trial and before and after study
Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors' attitudes, knowledge and clinical behaviour: a controlled trial and before and after study
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DOI：
10.1111/j.1365-2753.2007.00859.x
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发表时间：
2007-08-01
影响因子：
2.4
通讯作者：
Reis, Shmuel
中科院分区：
文献类型：
--
作者：
Shuval, Kerem;Berkovits, Eldar;Reis, Shmuel
基本原理、目的和目标 提供被动学习的传统继续医学教育项目已被证明在改变医生的临床行为方面效果不佳。以色列最大的健康维护组织（HMO）进行了多方面的循证医学（EBM）干预，试图促进医生态度、知识和临床行为的改变。迄今为止，还没有研究检验循证医学原则的教学与医生临床行为之间的关联。本研究通过对照试验和研究前后对干预方案进行了评估。评估的目标是二元的：首先，检查教育干预对家庭医生的测试预约表现和患者药物使用的影响；其次，评估干预措施对循证实践和知识态度的影响。方法对照试验以及研究前后。具有相似患者特征的初级保健诊所被随机分配到实验组或对照组。实验组医生参与EBM教育干预，对照组不参与干预。临床医生的测试预约表现和患者的药物使用情况均来自干预前、研讨会后和干预后的 HMO 数据库。对照试验的参与者包括 75 名医生及其 106 349 名患者。前后研究通过研讨会前后经过验证的问卷评估了干预医生（n = 70）的EBM态度和知识。结果EBM研讨会将干预医生的EBM知识得分从研讨会前的22.4/100提高到研讨会后的40.8/100（P = 0.000）。医生使用 Medline 提高了提出临床问题的能力，同时增强了搜索策略。在线性回归模型中，两个协变量，专业化（13 = 12.59；P = 0.001）和习惯阅读医学期刊（13 = 6.45；P = 0.052），最好地解释了医生EBM知识分数的方差，同时控制了干预前分数（R-2 = 0.569：P = 0.000）。对照试验的结果表明，干预医生和对照医生的测试预约表现以及患者的药物利用之间没有发现统计学上的显着差异。 结论 研究结果表明，干预对态度和知识产生积极影响；然而，没有发现对医生的测试预约表现和患者的药物利用有统计上的显着影响。干预措施无法改变医生的临床行为，可以通过改进未来的干预措施来弥补。
Rationale, aims and objectives Traditional continuing medical education programmes that offer passive learning have been shown to be poorly effective at changing doctors' clinical behaviour. A multifaceted evidence-based medicine (EBM) intervention was conducted at the largest health maintenance organization (HMO) in Israel, attempting to facilitate a change in doctors' attitudes, knowledge and clinical behaviour. No study thus far has examined the association between the teaching of EBM principles and doctors' clinical behaviour. This study evaluated the intervention pro gramme through a controlled trial and before and after study. The objective of the evaluation is binary: first, to examine the impact of an educational intervention on family doctors' test ordering performance and drug utilization by their patients; and second, to assess the impact of the intervention on attitudes towards evidence-based practice and knowledge.Methods Controlled trial and before and after study. Primary care clinics comprising similar patient characteristics were randomly allocated to the experimental or to the control group. Doctors in the experimental group participated in an EBM educational intervention, while the control group did not take part in the intervention. Clinicians' test ordering performance and their patients' drug utilization were derived from the HMO's database before intervention, after workshops and after intervention. Participants in the controlled trial consisted of 75 doctors and their 106 349 patients. The before and after study evaluated intervention doctors' (n = 70) EBM attitudes and knowledge through a validated questionnaire before and after workshops.Results EBM workshops enhanced intervention doctors' EBM knowledge scores from 22.4/100 before workshops to 40.8/100 after workshops (P = 0.000). Doctors improved their ability to formulate clinical questions while enhancing their search strategy using Medline. In a linear regression model, two covariates , specialization (13 = 12.59; P = 0.001) and habitually reading inedical journals (13 = 6.45; P = 0.052), best explained the variance in doctors' EBM knowledge scores, while controlling for pre-intervention scores (R-2 = 0.569: P = 0.000). Results from the controlled trial indicated that no statistically significant differences were found between intervention and control doctors' test ordering performances, and their patients' drug utilization.Conclusions The results of the study suggest that the intervention positively influenced attitudes and knowledge; however, no statistically significant impact was found on doctors' test ordering performance and on their patients' drug utilization. The intervention's inability to change doctors' clinical behaviour might be remedied by improving future interven-