Primary care physicians' response to dissemination of practice guidelines.
Primary care physicians' response to dissemination of practice guidelines.
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DOI：
10.1001/archfami.4.2.135
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发表时间：
1995-02-01
期刊：
影响因子：
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通讯作者：
Pawelak, J E
中科院分区：
文献类型：
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作者：
Gorton, T A;Cranford, C O;Pawelak, J E
背景：在制定临床实践指南方面付出了很多努力，但解决传播问题的研究相对较少。除非使用指导方针，否则收效甚微。本研究评估了三种传播哮喘指南的方法对医生行为和教育策略态度的影响。方法：将哮喘指南邮寄给阿肯色州三个地区健康教育中心的60名医生。在一个网站上的传播努力包括一个简短的摘要，“详细”医生的电话，以及一个继续医学教育会议。在第二个地点使用了计算机策略，在第三个地点使用了多媒体方法，包括传真信息、海报、录像带、录音带和继续医学教育会议。第四个有22名参与者的网站作为对比。数据是通过邮寄的问卷、门诊病历回顾和医生访谈收集的。在干预4个月后，计算基线和测试后评估之间的变化，计算用药情况，并将峰值流量监测使用情况与对照组进行比较(一般线性模型)。用回归分析确定与特定教育技术相关的医生和实践因素。结果：每个地点在药物使用或高峰流量监测方面都有所改善，但没有一个地点在所有地区都有所改善。多媒体、持续提醒的方法被广泛接受，但对计算机策略的支持很少。结论：进一步传播临床指南的努力应该包括多种形式，强调简短、简洁的总结和频繁的提醒。社会影响似乎发挥了作用，并将成为进一步研究的一个富有成果的领域。
BACKGROUND: Much effort has gone into producing clinical practice guidelines, but relatively few studies address dissemination issues. Unless guidelines are used, little is gained. This study evaluates the effect of three methods to disseminate asthma guidelines on physicians' behavior and attitudes toward education strategies.METHODS: Asthma guidelines were mailed to 60 physicians in three Area Health Education Centers in Arkansas. Dissemination efforts at one site featured a short summary, telephone calls by "detailing" physicians, and a continuing medical education conference. Computer strategies were used at the second site, and a multimedia approach with facsimile messages, posters, videocassettes, audiocassettes, and a continuing medical education conference was used at the third site. A fourth site with 22 participants served as a comparison. Data were collected by mailed questionnaires, outpatient chart reviews, and physician interviews. Changes between baseline and posttest assessments following a 4-month intervention were calculated for medication use, and peak flow monitoring use was compared with the control group (general linear model). Regression analyses were used to identify physician and practice factors associated with particular education techniques.RESULTS: Each site improved in the use of medications or peak flow monitoring, but none improved in all areas. The multimedia, continual reminder approach was well accepted but there was little support for the computer strategies.CONCLUSIONS: Further efforts to disseminate clinical guidelines should include a variety of formats with an emphasis on short, concise summaries and frequent reminders. Social influence appears to play a role and will be a fruitful area for further research.