COMPARATIVE OUTCOMES OF AMBULATORY PHARMACEUTICAL AGENTS

根据AHCPR RFA：HS-92-03，该项目的目标是 在门诊环境中改善药物治疗的结果 通过提供意见领袖，从而为执业医生提供最多 随机对照的Meta分析(M-AS)的数据汇集结果 使用我们最近开发的方法进行药物比较的试验(RCT)， 累积荟萃分析(CMA)和创建实时荟萃分析 系统方便了专家知识库的建立，便于提示 对有效和适当使用非卧床的认识 药物疗法。 选择了三个临床领域：1)大量患者 2)大量随机对照试验或随机对照试验的疾病 可供选择的药品；3)可供选择的地方 治疗方法具有广泛的成本影响；以及4)那些没有 目前正在AHCPR港口项目中进行评估。这三个领域 分别是：抗生素使用、高血压和充血性心力衰竭。 具体来说，我们的目标是：1)开发RTMAS，通过应用 CMA技术和一种组织RCT数据的矩阵方法和 并购结果；2)建立三个区域技术合作项目的综合数据库 临床范围和进行随机对照试验的CMA以确定疗效 流动药品；3)传播随机对照试验数据库和并购 将结果提供给意见领袖、执业医生和研究人员；4) 来检验这样的假设：意见领袖是不一致的 在门诊领域对已发表的随机对照试验的反应滞后，因为他们 在住院期间；以及5)评估并购对 意见领袖建议。 在四年的时间里，将完成以下任务 这些目标：1)开发以计算机为基础的RTMAS，以常规地组织 更新和显示流动药品的RCT和M-AS 高效、易于使用和易于理解的临床领域 矩阵格式；2)开发和维护最新的随机对照试验数据库和 M-如上所述的以下临床；3)之前的更新 已发表的M-AS和应用CMAS确定疗效和结果 上述药物疗法的非卧床使用情况；4) 通过在适当的期刊上发表文章和发表意见来传播并购 领袖；5)监督发表在期刊上的意见领袖建议 复习文章和教科书章节并比较它们的 向CMA提出建议；6)研究已公布的M-AS对 意见领袖通过执行引文分析提出建议。

The goal of this project, in response to AHCPR RFA:HS-92-03, is to improve the outcomes of pharmaceutical therapies in ambulatory settings by providing opinion leaders and thus practicing physicians with up-to- date pooled results from meta-analyses (M-As) of randomized controlled trials (RCTs) of drug comparisons using our recently developed methods, cumulative meta-analysis (CMA), and creating a Real-Time Meta- Analysis System to facilitate experts knowledge base and facilitate the prompt recognition of effective and the appropriate use of ambulatory pharmaceutical therapies. Three clinical areas have been chosen that: 1) afflict large numbers of the population; 2) disorders for which a large number of RCTs or alternative pharmaceuticals are available; 3) where alternative therapies have wide ranging cost implications; and 4) those not currently being evaluated in AHCPR PORT projects. These three areas are: antibiotic usage, hypertension, and congestive heart failure. Specifically, our aims are to: 1) to develop the RTMAS, by applying the techniques of CMA and a matrical method of organizing RCT data and M-A results; 2) to develop comprehensive databases of RCTs in the three clinical areas and perform CMAs of RCTs to determine the efficacy of ambulatory pharmaceuticals; 3) to dissemination RCT databases and M-A results to opinion leaders, practicing physicians, and researchers; 4) to test the hypothesis that opinion leaders are as inconsistent and lagging in response to published RCTs in the ambulatory field as they are in the inpatient setting; and 5) to assess the impact of M-As on opinion leader recommendations. Over a four-year period, the following tasks will be done to accomplish these aims: 1) develop a computer-based RTMAS to organize, routinely update and display RCTs and M-As of ambulatory pharmaceuticals in the clinical areas in an efficient, easy-to-use, and easy-to-understand matrix format;2) develop and maintain up-to-date databases of RCTs and M-As in the following clinical mentioned above; 3) update previously published M-As and applying CMAs to determine the efficacy and outcomes of the ambulatory use of the above pharmaceutical therapies; 4) disseminate M-As by publication in appropriate journals and to opinion leaders; 5) monitor opinion leader recommendations published in journal review articles and textbook chapters and comparing their recommendations with CMAs; 6) study the impact of published M-As on opinion leader recommendations by performing citation-analyses.