Implementing preventive services. Success and failure in an outpatient trial.
Implementing preventive services. Success and failure in an outpatient trial.
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落实预防性服务。
DOI：
10.1001/archinte.1990.00390230083011
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发表时间：
1990
影响因子：
--
通讯作者：
D. Belcher
中科院分区：
文献类型：
--
作者：
D. Belcher
医生支持预防，但只提供低水平的筛查、健康咨询和免疫接种。1981年至1986年，在西雅图（华盛顿）退伍军人事务医疗中心进行了一项随机对照试验，以评估以下三种提供预防服务方法的有效性：（1）以医生为导向的模式，包括教育和激励，列出推荐活动的图表流程表，以及对绩效的定期反馈;（2）病人教育模式，即向病人邮寄一份资料性小册子，建议他们向医生寻求预防服务，如病人手持的袖珍指南所述;以及（3）健康促进诊所，邀请病人参加。对照组接受常规护理。共有1224例男性门诊患者入组本试验。12个年龄特定的预防活动的基线预防率低于25%。5年试验期间的对照组比率和两种教育模式（无论是单独还是作为联合干预）的比率都没有变化。只有健康促进诊所模式是有效的，在第一年将预防率提高了两倍，并在所有5年中保持这一水平。在一个专门的多诊所环境中，很难改变经验丰富的医生和他们的长期患者的临床角色。提供一个独立的健康促进诊所的选择是受欢迎的病人，绕过看门人的障碍，是合理的成本，并保证更广泛的应用。
Physicians endorse prevention but provide only low levels of screening, health counseling, and immunization. Between 1981 and 1986, a randomized controlled trial was conducted at the Seattle (Wash) Veterans Affairs Medical Center to assess the effectiveness of the following three methods of delivery of preventive services: (1) a physician-oriented model that includes education and motivation, a chart flowsheet listing recommended activities, and periodic feedback about performance; (2) a patient education model in which patients were mailed an informative brochure advising them to ask physicians for preventive services as depicted in a patient-held pocket guide; and (3) a health promotion clinic that patients were invited to attend. A control group received their usual care. A total of 1224 male outpatients were enrolled in the trial. Baseline prevention rates for 12 age-specific prevention activities were below 25%. Neither the control group rates during the 5-year trial nor the rates for the two educational models, either singly or as a combined intervention, changed. Only the health promotion clinic model was effective, tripling prevention rates in its first year and sustaining these levels for all 5 years. It is difficult to change the clinic roles of experienced physicians and their long-term patients in a specialized multiclinic setting. Providing a separate health promotion clinic option is popular with patients, bypasses gatekeeper barriers, is reasonable in cost, and warrants wider application.
医生对患者戒烟教育的看法和实践的调查。
影响因子：
5.1
作者：
Rimer,BK;Strecher,VJ;Keintz,MK;Engstrom,PF
通讯作者：
Engstrom,PF