Sponsored Health IT and Evidence-Based Prescribing among Medical Residents

描述（由申请人提供）：很大一部分医生开的处方没有证据基础，这可能导致药物滥用和误用，增加发病率和死亡率，并增加医疗保健费用。尽管有多种因素可以影响医生的处方，但制药公司等行业的赞助信息已被证明会导致非循证处方（non-EBP）。随着医疗保健行业接受健康信息技术（HIT），医生越来越多地使用智能手机和平板电脑与患者进行即时决策，赞助消息已经开始渗透到医生的HIT环境中。由于制药公司的这种定向营销形式相对较新，尚未完全理解，我们需要检查其与已知导致非ebp的因素（系统级，医生级和患者级）的关系。此外，需要培训计划来重申在医生的健康IT环境中存在赞助消息传递的EBP的基本原则。因此，我们开发了一个基于网络的HIT干预，名为SMARxT，植根于媒体素养的原则，针对实习医生（住院医师），以教他们如何有效地导航他们的HIT环境并抵制赞助信息。为了确定SMARxT在住院医师项目中的初步有效性、可行性和可接受性，需要在一组住院医师中进行试点测试和评估，如本申请所述。首先，我们将对SMARxT项目健康信息技术干预进行试点测试和过程评估。招募来自当地培训项目的60名家庭医学和内科住院医师参与干预，并在干预完成后立即和6个月后完成定量和定性评估。这些评估将衡量居民对干预的可行性和可接受性的看法。此外,特定的

DESCRIPTION (provided by applicant): A substantial proportion of prescriptions written by physicians are not evidence based, which can result in drug abuse and misuse, increased morbidity and mortality, and rising health care costs. Although a variety of factors can influence physician prescribing, sponsored messaging by industry such as pharmaceutical companies has been shown to lead to non-evidence-based prescribing (non-EBP). As the healthcare industry has embraced health information technology (HIT) and physicians have increased their use of smartphones and tablets with point-of-care decision-making with their patients, sponsored messaging has begun to penetrate physicians' HIT environment. Because this form of targeted marketing by pharmaceutical companies is relatively new and not completely understood, we need to examine its relationships with the factors (system-level, physician-level and patient-level) that have been known to lead to non-EBP. Additionally, training programs are needed to reaffirm the basic principles of EBP in the presence of sponsored messaging in physicians' health IT environment. Thus, we have developed a Web-based HIT intervention, titled SMARxT, rooted in the tenets of media literacy and targeted at physicians-in-training (residents), in order to teach them how to effectively navigate their HIT environment and counteract sponsored messaging. In order to determine the preliminary efficacy, feasibility and acceptability of SMARxT for residency programs, this HIT intervention needs to be pilot tested and evaluated with a group of residents, described in this application. First, we will conduct a pilot test and process evaluation of the SMARxT program health IT intervention. Sixty family medicine and internal medicine residents from local training programs will be recruited to participate in the intervention and complete quantitative and qualitative assessments immediately after completion and 6 months later. These assessments will measure the residents' perceptions of feasibility and acceptability of the intervention. Additionally, specific process evaluation metrics will assess the implementation fidelity of the intervention. Second, the same 60 residents will participate in an outcome evaluation of the SMARxT program health IT intervention. This evaluation will be conducted concurrently with the process evaluation. A time-series quasi- experimental design-pre-test (T1), post-test (T2), and follow-up (T3)-will be employed, during which all residents will be asked to complete quantitative assessments. These assessments will measure the preliminary efficacy of the intervention in addressing the residents' knowledge and attitudes towards EBP as well as likely EBP behavior. The results from the pilot test and evaluation of the SMARxT program will allow us to make modifications and take steps to implement the program in other residency programs nationwide.