Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial.
Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial.
复制标题
计算机生成的循证护理建议能否增强哮喘和慢性阻塞性肺疾病的循证管理？
DOI：
10.1111/j.1475-6773.2005.00368.x
复制
发表时间：
2005
影响因子：
3.4
通讯作者：
Wolinsky,FredricD
中科院分区：
文献类型：
--
作者：
Tierney,WilliamM;Overhage,JMarc;Murray,MichaelD;Harris,LisaE;Zhou,Xiao-Hua;Eckert,GeorgeJ;Smith,FayeE;Nienaber,Nancy;McDonald,ClementJ;Wolinsky,FredricD
目的：将循证指南转化为临床实践一直不一致。我们进行了一项随机对照试验，研究在计算机工作站上写医嘱时，医生会收到基于指南的护理建议。研究设置。市中心的学术性普通内科实践。研究设计。随机对照试验，共有246名医生（25%为普通内科医生，75%为内科住院医生）和20名门诊药师参加。我们招募了706名患有哮喘或慢性阻塞性肺病的初级保健患者。在使用计算机工作站撰写医嘱或填写处方时，向随机一半的医生和药剂师提供有关药物和监测的护理建议。一个2 × 2因子随机分组的实践会议和药剂师导致四组patients：医生干预，药剂师干预，干预和controls.Data提取/收集方法。遵守指南和临床活动进行了评估，使用患者的电子病历。健康相关的生活质量，服药依从性，并与护理满意度进行了评估，使用电话问卷。主要调查结果。在他们的一年在研究中，患者平均进行了五次预定的初级保健访问。两组之间在遵循护理建议、一般或特定条件的生活质量、对医生或药剂师的满意度、药物依从性、急诊室就诊或住院方面没有差异。接受干预的医生有显着更高的总医疗保健费用。医生对指南的态度是喜忧参半。Conclusions.在计算机工作站上向医生和药剂师提供的护理建议对反应性气道疾病患者的护理效果没有影响。
Objective.Translation of evidence‐based guidelines into clinical practice has been inconsistent. We performed a randomized, controlled trial of guideline‐based care suggestions delivered to physicians when writing orders on computer workstations.Study Setting.Inner‐city academic general internal medicine practice.Study Design.Randomized, controlled trial of 246 physicians (25 percent faculty general internists, 75 percent internal medicine residents) and 20 outpatient pharmacists. We enrolled 706 of their primary care patients with asthma or chronic obstructive pulmonary disease. Care suggestions concerning drugs and monitoring were delivered to a random half of the physicians and pharmacists when writing orders or filling prescriptions using computer workstations. A 2 × 2 factorial randomization of practice sessions and pharmacists resulted in four groups of patients: physician intervention, pharmacist intervention, both interventions, and controls.Data Extraction/Collection Methods.Adherence to the guidelines and clinical activity was assessed using patients' electronic medical records. Health‐related quality of life, medication adherence, and satisfaction with care were assessed using telephone questionnaires.Principal Findings.During their year in the study, patients made an average of five scheduled primary care visits. There were no differences between groups in adherence to the care suggestions, generic or condition‐specific quality of life, satisfaction with physicians or pharmacists, medication compliance, emergency department visits, or hospitalizations. Physicians receiving the intervention had significantly higher total health care costs. Physician attitudes toward guidelines were mixed.Conclusions.Care suggestions shown to physicians and pharmacists on computer workstations had no effect on the delivery or outcomes of care for patients with reactive airways disease.