Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat
Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat
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DOI：
10.1136/bmj.325.7360.367
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发表时间：
2002-08-17
影响因子：
105.7
通讯作者：
Herrin, J
中科院分区：
文献类型：
--
作者：
Flottorp, S;Oxman, AD;Herrin, J
Objective To assess effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat.Design Unblinded，cluster randomized pretest-post-test trial. Set 142 general practices in Norway.Participants 72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throats serving as control for each other.尿路感染组中的59名实践者和喉咙痛组中的61名实践者完成了研究。在16939次咽喉痛咨询和9887次尿路感染咨询中测量了结果。制定干预措施是为了克服已查明的执行准则的障碍。量身定制的干预措施的主要组成部分是患者教育材料，基于计算机的决策支持和提醒，增加电话咨询费用，以及全科医生和实践助理的互动课程。结果咽喉痛组患者在干预后接受抗生素治疗的可能性降低了3%。干预组中有尿路感染症状的女性进行实验室检查的可能性降低了5%。两组其他结局无显著差异。在抗生素处方率，使用实验室检查和电话咨询，并在所有三个结果measurement.Conclusions的变化程度的做法之间发现了很大的变化被动交付，针对确定的障碍，以改变复杂的干预措施在改变做法的影响不大。
Objective To assess the effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat.Design Unblinded, cluster randomised pretest-post-test trial.Setting 142 general practices in Norway.Participants 72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throats serving as controls for each other. 59 practices in the urinary tract infection group and 61 practices in the sore throat group completed the study. Outcomes were measured in 16 939 consultations for sore throat and 9887 consultations for urinary tract infection. InterventionsInterventions were developed to overcome identified barriers to implementing the guidelines. The main components of the tailored interventions were patient educational material, computer based decision support and reminders, an increase in the fee for telephone consultations, and interactive courses for general practitioners and practice assistants.Main outcome measures Changes in rates of use of antibiotics, laboratory tests, and telephone consultations.Results Patients in the sore throat group were 3% less likely to receive antibiotics after the intervention. Women with symptoms of urinary tract infection in the intervention group were 5% less likely to have a laboratory test ordered. No significant differences were found between the groups for the other outcomes. Large variation was found across the included practices in the rates of antibiotic prescription, use of laboratory tests and telephone consultations, and in the extent of change for all three outcome measures.Conclusions Passively delivered, complex interventions targeted at identified barriers to change had little effect in changing practice.