Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation
Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation
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DOI：
10.1136/bmj.318.7194.1324
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发表时间：
1999-05-15
影响因子：
105.7
通讯作者：
Armstrong, D
中科院分区：
文献类型：
--
作者：
Howitt, A;Armstrong, D
目的探讨房颤抗血栓治疗这一循证治疗方法在全科医学中的可行性。对符合抗血栓治疗标准的房颤患者进行设计审核和定性研究，并对符合抗血栓治疗条件的患者进行教育干预。研究对象为56例有房颤病史的患者。干预评估和访谈以确定患者对抗血栓治疗的看法。主要结果：13239例患者中，132例有房颤病史，其中100例有血栓栓塞症的风险。研究结束后，52名患者服用了华法林。在剩下的48名患者中(其中41名正在服用阿司匹林)，8名患者病情严重，无法参与，16名患者无法同意，4名患者拒绝接受采访，20名患者拒绝接受华法林治疗。根据最小的临床重要差异来衡量，拒绝华法林的患者倾向于寻求比服用华法林的患者更高水平的益处。访谈中获得的定性数据表明，患者的健康信念是决定他们选择治疗的重要因素。结论患者不愿服用华法林似乎是限制最终服用华法林的人数的主要因素。
Objective To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice.Design Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatmentSetting South east England.Subjects 56 patients with a history of atrial fibrillation.Interventions Assessment and interview to ascertain patients' views on antithrombotic treatmentMain outcome measures Number of patients receiving antithrombotic treatmentResults Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients were taking warfarin. Of the remaining 48 patients (of whom 41 were taking aspirin), eight were too ill to participate, 16 were unable to consent, four refused the interview and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as measured by the minimal clinically important difference. Qualitative data obtained during the interviews suggested that patients' health beliefs were important factors in determining their choice of treatmentConclusion Patients' unwillingness to take warfarin seemed to be a major factor in limiting the number who would eventually take it.