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首页> 美国卫生研究院文献>Quality in Health Care : QHC >A trial of education prompts and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease
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A trial of education prompts and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease

机译：一项教育提示和意见领袖的试验以改善初级保健医生对缺血性心脏病患者进行脂质修饰治疗的处方

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>Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. >Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). >Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. >Results: At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. >Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.
机译：>背景：最近的临床试验表明，脂质修饰疗法可改善缺血性心脏病（IHD）和低水平高密度脂蛋白（HDL）胆固醇患者的结局。然而，这些试验的结果尚未在临床实践中得到广泛实施。 >目标：开发并测试旨在提高调脂治疗处方率并确定三种不同提示（病历，患者信函或计算机图表提示）的相对有效性的干预措施。 >方法：该研究在美国退伍军人事务医疗中心的11个部门进行。在研究设计前后，在五个干预部位和六个匹配的对照部位之间比较了干预对接受脂质修饰治疗的合格患者比例的影响。此外，干预诊所内的92位提供者被随机分配以接收三个提示之一。使用逻辑回归模型分析数据，该模型结合了术语以说明数据的聚类性质。 >结果：在干预现场，处方率从干预前的8.3％增加到干预期间的39.1％（OR = 6.5，95％CI 5.2至8.2，p <0.0001），但仍保持不变在控制地点保持不变。组（对照组与干预组）和时间段之间的相互作用非常显着（p <0.0001）。在干预期间，干预地点接受处方调整的几率比对照地点高出3.1倍（95％CI为2.1至4.7）。总体而言，三个提示组之间的处方率没有显着差异。但是，提示组和站点之间存在显着的交互作用，表明提示的效果因站点而异。 >结论：针对初级保健提供者的干预措施，包括培训班，意见领袖的影响和提示，可大幅提高调脂治疗的处方率。

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