Changing physicians' behavior: what works and thoughts on getting more things to work.
Changing physicians' behavior: what works and thoughts on getting more things to work.
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DOI：
10.1002/chp.1340220408
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发表时间：
2002-01-01
期刊：
影响因子：
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通讯作者：
Thomas, Ruth E
中科院分区：
文献类型：
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作者：
Grimshaw, Jeremy M;Eccles, Martin P;Thomas, Ruth E
卫生服务研究一直表明，以研究为基础的最佳临床实践与医生实际工作之间存在差距。传统上，医学专业的表现就好像在同行评审的期刊上传播研究成果将消除这一差距，即使专业人士通常每周只有不到1小时的阅读时间。这个问题由于医生没有接受过评估已发表研究的一般培训而变得更加复杂，因为无论如何，这些研究的质量都是参差不齐的。有兴趣改变他们的做法的医生也遇到组织，同行团体和个人的障碍，同时，他们面临的信息过载和病人的期望。总之，医生管理信息的能力是不堪重负的。本文总结了通过综合现有证据来改善医生信息管理的举措，并描述了传播和实施策略的有效性和效率的现有证据基础。我们的结论是，有一个不完善的证据基础，以支持决策的战略，可能是适当的和有效的，在不同的情况下。由于这个问题是复杂的概念化医生的行为变化的理论基础的缺乏，我们建议探索行为理论的适用性，以了解专业的行为变化。我们还建议探索使用基于理论的过程评估的传播和实施策略的随机试验，以进一步测试理论，并探讨因果机制。需要进一步的研究，以探索提供者行为的决定因素，以更好地确定可修改和不可修改的效果修饰符，开发识别障碍和促进因素的方法，以改变，并估计在不同的障碍和效果修饰符存在的传播和实施策略的效率。
Health services research consistently demonstrates a gap between research-based best clinical practice and what doctors actually do. Traditionally, the profession of medicine has behaved as if dissemination of research findings in peer-reviewed journals will eliminate this gap, even though professionals typically have less than 1 hour per week to read. This problem is complicated by the fact that physicians have not been trained generally to appraise published research, which is of variable quality in any event. Physicians interested in changing their practices also encounter organizational, peer group, and individual barriers at the same time as they face information overload and patient expectations. In a word, physicians' abilities to manage information is overwhelmed. This article both summarizes initiatives to improve physicians' information management through efforts to synthesize available evidence and describes the current evidence base of effectiveness and efficiency of dissemination and implementation strategies. We conclude that there is an imperfect evidence base to support decisions regarding strategies that are likely to be appropriate and effective under varying circumstances. Since this problem is compounded by the lack of a theoretical base for conceptualizing physician behavior change, we suggest exploring the applicability of behavioral theories to the understanding of professional behavior change. We also suggest exploring the use of theory-based process evaluations alongside randomized trials of dissemination and implementation strategies to further test theories and to explore causal mechanisms. Further research is required to explore determinants of provider behavior to better identify modifiable and non-modifiable effect modifiers, to develop methods of identifying barriers and facilitators to change, and to estimate the efficiency of dissemination and implementation strategies in the presence of different barriers and effect modifiers.