A survey of primary care patients' readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada.
A survey of primary care patients' readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada.
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DOI：
10.1186/s13104-016-2103-6
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发表时间：
2016-06-10
影响因子：
1.8
通讯作者：
Tannenbaum, Cara
中科院分区：
文献类型：
--
作者：
Silverstein, William;Lass, Elliot;Tannenbaum, Cara
背景：已经建立了诸如明智选择之类的策略来识别被认为是低价值的干预措施的过度使用。减少低价值的做法需要患者理解为什么某些干预措施不再被推荐。本研究的目的是确定老年人是否接受并认为自己已经准备好放弃每年进行心电图检查、腰痛影像学检查、鼻窦炎使用抗生素、失眠使用镇静催眠药物以及治疗痴呆行为症状使用抗精神病药物的理由。方法：一项自我管理的iPad调查被分发给50岁及以上的连续患者，出现在加拿大安大略省的三个初级保健门诊诊所。在等待看医生期间能够并愿意完成调查的患者的数据也包括在内。该调查询问了在这五个主题之一的“明智选择加拿大”患者教育手册之前和之后，围绕目标低价值干预措施的知识、态度和行为。一部分患者同意在诊所访问后参加半结构化访谈。结果：344例患者（平均年龄63岁，50 ~ 88岁，女性59%）阅读资料并完成调查。48% （95% CI 43-53%）的患者打算与医疗保健提供者讨论这些信息。45% （95% CI 40-51%）表示希望改变当前的低价值实践。大约三分之二表示他们不会改变未来行为的人解释说，这是因为他们已经支持明智选择的价值观。在阅读了《明智选择》手册后，48% （95% CI 38-57%）的参与者对心电图测试、74% （95% CI 65-82%）的抗精神病药物使用、66% （95% CI 52-78%）的抗生素治疗鼻窦炎、60% （95% CI 46-72%）的腰痛成像和40% （95% CI 26-55%）的老年人镇静催眠药物使用的知识与年龄、性别和教育无关。结论：大多数初级保健患者似乎准备放弃采用低价值的做法。在诊所候诊室提供教育可以帮助提高对不必要护理的认识。
BACKGROUND: Strategies such as Choosing Wisely have been established to identify the overuse of interventions considered as low-value. Reduction of low-value practices will require patients to understand why certain interventions are no longer recommended. The objective of this study was to determine whether older adults accept the rationale for and perceive themselves ready to de-adopt annual electrocardiogram testing, imaging for low back pain, the use of antibiotics for sinusitis, the use of sedative-hypnotics for insomnia, and the use of antipsychotics to treat behavioural symptoms of dementia.METHODS: A self-administered iPad survey was distributed to consecutive patients aged 50years and older, presenting to three primary care outpatient practices in Ontario, Canada. Data from patients who were able and willing to complete the survey while waiting to see their physician were included. The survey queried knowledge, attitudes and behaviours around the targeted low-value interventions, before and after exposure to a Choosing Wisely Canada patient educational brochure on one of these five topics. A subset of patients agreed to participate in a semi-structured interview after their clinic visit.RESULTS: Three-hundred and forty-four patients (mean age 63, range 50-88, 59% female) read the materials and completed the survey. Forty-eight percent (95% CI 43-53%) intended to discuss the information with a healthcare provider. Forty-five percent (95% CI 40-51%) expressed a desire to change current low-value practices. Approximately two-thirds of those who indicated they would not change future behaviours explained that it was because they were already espousing the Choosing Wisely values. After reading the Choosing Wisely brochures, knowledge improved independent of age, sex and education in 48% (95% CI 38-57%) of participants about electrocardiogram testing, in 74% (95% CI 65-82%) about use of antipsychotics, in 66% (95% CI 52-78%) about use of antibiotics for sinusitis, in 60% (95% CI 46-72%) about imaging for low back pain, and in 40% (95% CI 26-55%) about sedative-hypnotic use in the elderly.CONCLUSIONS: The majority of primary care patients seem ready to de-adopt low-value practices. Provision of education in clinic waiting rooms can help improve knowledge around unnecessary care.