Dissemination of the AHCPR clinical practice guideline in community health centres
Dissemination of the AHCPR clinical practice guideline in community health centres
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DOI：
10.1136/tc.11.4.329
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发表时间：
2002-12-01
期刊：
影响因子：
5.2
通讯作者：
Kazura, A
中科院分区：
文献类型：
--
作者：
DePue, JD;Goldstein, MG;Kazura, A
目的：评估卫生保健政策和研究局（AHCPR）戒烟临床实践指南在社区卫生中心的传播。设计：试验前和试验后。设置：罗得岛的14个社区卫生中心。受试者：在前后横断面连续样本中，分别使用1798和1591名患者接触者评估了提供者的表现，干预措施：3次，每次1小时的现场提供者培训课程，内容涉及审查有效的烟草干预措施、使用办公系统和烟草咨询技能建设。（询问、建议、协助和安排随访）。结果：虽然询问和建议的平均绩效率有所提高，（分别从30%到44%和19%到26%，术前和术后），仅在某些访视类型中发现显著增加，患者性别之间存在进一步差异。除了产科/妇科（ob/gyn）访问类型外，所有请求都有显着增加。每年体检和首次访视的患者更有可能在所有时间点被询问，而男性比女性更有可能在急性访视时被询问。尽管女性患者在培训后的建议中表现出差异性增加，但建议，协助和安排在时间上没有显著增加。忠告是显着更有可能在每年的体检和第一次访问，和不太可能在OB/妇科访问，在所有的时间点。结论：这一指南的传播工作导致相当不同的供应商咨询率在患者性别和访问类型。实施指南可能需要更持续的努力，并在更高的政策层面加强多种战略，以更充分地将烟草干预措施纳入所有吸烟患者的常规初级保健实践。
Objective: To evaluate dissemination of the Agency for Health Care Policy and Research (AHCPR) Smoking cessation clinical practice guideline in community health centres.Design: Pre- and post-trial.Setting: Fourteen community health centres in Rhode Island.Subjects: Provider performance was assessed with 1798 and 1591 patient contacts, in pre-post cross sectional consecutive samples, respectively, and 891 contacts at one year follow up.Interventions: Three, one hour on-site provider training sessions, on review of effective tobacco interventions, use of office systems, and tobacco counselling skill building.Outcome measures: Chart documentation of four A's (Ask, Advise, Assist, and Arrange follow up) at most recent primary care visit.Results: While average performance rates increased for Ask and Advise (from 30% to 44%, and 19% to 26%, pre-post, respectively), significant increases were found only for some visit types, with further differences by patient sex. There were significant increases for Ask for all except obstetric/gynaecological (ob/gyn) visit types. Patients at yearly physicals and first visits were more likely to be asked at all time points, while males were more likely to be asked at acute visits than were females. There were no significant increases for Advise, Assist, and Arrange across time, although female patients showed a differential increase in Advise post-training. Advise was significantly more likely in yearly physicals and first visits, and less likely in ob/gyn visits, at all time points.Conclusions: This guideline dissemination effort resulted in quite different provider counselling rates across patient sexes, and visit types. Guideline implementation may require more sustained efforts, with multiple strategies, which are reinforced at higher policy levels, to more fully integrate tobacco interventions into routine primary care practice with all patients who smoke.