Interactional group discussion: Results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities
Interactional group discussion: Results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities
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DOI：
10.1016/0277-9536(95)00391-6
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发表时间：
1996-04-01
影响因子：
5.4
通讯作者：
Santoso, B
中科院分区：
文献类型：
--
作者：
Hadiyono, JEP;Suryawati, S;Santoso, B
在印度尼西亚，注射通常被过度使用。在公共卫生机构就诊的患者中，超过60%的人至少接受了一次注射，这增加了临床风险，并产生了不利的经济影响。这项研究评估了一种创新的行为干预--互动小组讨论(IGD)--在减少过度注射方面的有效性。这项研究是在一个地区进行的对照试验，24个公共卫生中心随机分为干预组和对照组。干预组邀请处方医生参加1个IGD，每个IGD由6名处方医生和6名患者组成；在4周内共举行24次IGD，所有受邀的处方医生都参加。这些小组持续90-120分钟，由一名行为科学家和一名临床医生协助，他们也是科学资源人。行为改变的假想机制包括现实测试处方者对患者信念的假设，传授关于注射效果的科学信息，以及建立关于正确行为的同伴规范。结果通过一项涵盖干预前3个月和干预后3个月的回溯性处方调查来衡量，每个中心每月100张处方的样本。分别计算每个中心的注射率和每个处方的平均用药数量，并使用t检验来比较两组结果的前后变化。结果显示，干预组的注射使用率从69.5%下降到42.3%，而对照组的注射使用率从75.6%下降到67.1%[干预比对照组-18.7.0%，95%CI=(-31.1%，-6.4%)，P<；0.025]。每个处方的平均用药数量也显著减少[-0.37个药物/患者，95%CI=(-0.04，-0.52)，P<；0.05]，表明注射用药没有被其他药物取代。我们的结论是，IGD显著减少了过度注射。建议尝试其他行为干预措施，提高合理用药水平。
Injections are commonly overused in Indonesia. More than 60% of patients attending public health facilities receive at least one injection, which increases clinical risk and has adverse economic impact. This study assesses the efficacy of an innovative behavioral intervention, the Interactional Group Discussion (IGD), for reducing the overuse of injections. This study was a controlled trial in a single district with 24 public health centers randomized to intervention and control groups. Prescribers in the intervention group were invited to one IGD, each of which consisted of 6 prescribers and 6 patients; a total of 24 IGDs were held in a 4-week period, and all invited prescribers participated. The groups, which lasted 90-120 minutes, were facilitated by a behavioral scientist and a clinician, who also served as a scientific resource person. The hypothesized mechanism of behavior change involved reality testing prescribers' assumptions about patient beliefs, imparting scientific information about injection efficacy, and establishing peer norms about correct behavior. Outcomes were measured by a retrospective prescribing survey covering the periods 3 months before and 3 months after the intervention, with samples of 100 prescriptions per center per month. Rates of injection and average number of drugs per prescription were computed separately for each center, and t-tests were used to compare pre-post changes in outcomes in both groups. Results showed a significant decrease in injection use from 69.5 to 42.3% in the intervention group, compared to a decrease from 75.6 to 67.1% among controls [-18.7.0% intervention vs control, 95% CI = (-31.1%, -6.4%), P < 0.025]. There was also a significant reduction in average number of drugs per prescription [-0.37 drugs prescribed per patient, 95% CI = (-0.04, -0.52), P < 0.05], indicating that injections were not substituted with other drugs. We conclude that the IGD significantly reduces the overuse of injections. It is suggested to try out other behavioral interventions to improve the rational use of drugs.