Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial.
Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial.
复制标题
努力提高对国家胆固醇教育计划指南的遵守情况。
DOI：
--
复制
发表时间：
1992
影响因子：
--
通讯作者：
Randall D. Cebul
中科院分区：
文献类型：
--
作者：
L. Headrick;Theodore Speroff;Hi Pelecanos;Randall D. Cebul
研究目的
我们比较了三种方法，以提高遵守国家胆固醇教育计划（NCEP）的实践指南。
设计
随机对照试验。
设置
一家大型城市教学医院的学术小组实践。
参与者
研究医生是在同等门诊就诊的PG-2和PG-3居民（N = 33）的3个同等组。这些居民的连续性患者（N = 240），如果他们年龄小于66岁，在干预期间看到他们的主治医生，没有怀孕，没有严重的缩短寿命的非心脏疾病。
干预措施
在5周内实施了三项干预措施。对照组医生（第1组）仅通过医生胆固醇教育计划（PCEP）提供标准讲座。第2组医生提供PCEP讲座，并收到每个合格患者图表上的NCEP指南的通用图表提醒。第3组医生提供PCEP讲座，并及时收到患者特定的反馈，包括确认最近的血脂值和管理，并明确建议采取进一步行动。在PCEP讲座前后进行血脂紊乱知识的测试，并在干预期后调查医生的态度。
测量值和主要结果
三组在基线（干预前）对NCEP建议的依从性（平均39%）和医生的知识方面相似。各组患者在冠状动脉疾病危险因素和胆固醇值方面相似。组2和组3的依从性显著改善（分别为7.6%和10.6%），但组1无改善（4.5%）。重要的是，各组之间的改善没有差异。然而，在探索性分析中，在第3组中，改善的依从性与每个提供者看到的患者数量之间存在显着相关性，而在第1组或第2组中没有观察到。值得注意的是，依从性的变化与PCEP讲座出席率（出席者与未出席者分别为8.6%和8.1%），研究生培训水平，基线或后期知识测试或患者因素无关。干预后调查显示，医生明显高估了他们个人对NCEP指南的依从性，尽管有强烈的支持，临床工作，将屏幕患者的脂质紊乱独立于医生的倡议。
结论
这项研究提出了关于教育的有效性的问题，以提高遵守NCEP的指导方针。及时、个性化反馈的有效性和效率应在较长时间的研究中加以探讨。对我们的调查和其他预防做法研究的答复提出了创新的替代办法。
STUDY OBJECTIVE
We compared three approaches for improving compliance with the practice guidelines of the National Cholesterol Education Program (NCEP).
DESIGN
A randomized controlled trial.
SETTING
Academic group practices of a major urban teaching hospital.
PARTICIPANTS
Study physicians were three equivalent groups of PG-2 and PG-3 residents (N = 33) seeing patients in equivalent outpatient clinics. Continuity patients of these residents were included (N = 240) if they were younger than 66 years, saw their primary physician during the intervention period, were not pregnant, and had no serious life-shortening noncardiac illnesses.
INTERVENTIONS
Three interventions were implemented over a 5-week period. Control group physicians (group 1) were offered only a standard lecture provided through the Physician Cholesterol Education Program (PCEP). Group 2 physicians were offered the PCEP lecture and also received generic chart reminders of the NCEP guidelines on each eligible patient's chart. Group 3 physicians were offered the PCEP lecture and also received timely patient-specific feedback, including acknowledgement of recent lipid values and management, and explicit recommendations for further action. Knowledge of lipid disorders was tested before and after the PCEP lecture, and physicians' attitudes were surveyed following the intervention period.
MEASUREMENTS AND MAIN RESULTS
The three groups were similar in baseline (preintervention) compliance with NCEP recommendations (average, 39%) and physicians' knowledge. Patients were similar across groups in number of coronary artery disease risk factors and cholesterol values. Significant within-group improvements in compliance were noted for groups 2 and 3 (7.6% and 10.6%, respectively), but not for group 1 (4.5%). Importantly, there were no differences observed in improvements across groups. In exploratory analyses, however, there was a significant correlation between improved compliance and the number of patients seen by each provider in group 3 that was not observed in groups 1 or 2. Notably, changes in compliance were unrelated to PCEP lecture attendance (8.6% vs 8.1% for attenders vs nonattenders, respectively), level of postgraduate training, baseline or later tests of knowledge, or patient factors. The postintervention survey revealed marked overestimation by physicians of their personal compliance with NCEP guidelines, although there was strong support for clinic efforts that would screen patients for lipid disorders independent of physician initiative.
CONCLUSIONS
This study raises questions about the effectiveness of education alone for improving compliance with NCEP guidelines. The effectiveness and efficiency of timely, individualized feedback should be explored in studies over a longer period. Innovative alternative approaches are suggested by the responses to our survey and other research in preventive practices.
老年人的健康促进和疾病预防。
影响因子：
--
作者：
Black,JS;Sefcik,T;Kapoor,W
通讯作者：
Kapoor,W
影响因子：
--
作者：
Bostick,RM;Luepker,RV;Kofron,PM;Pirie,PL
通讯作者：
Pirie,PL