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首页> 外文期刊>Journal of Health Services Research & Policy >Improving referrals for glue ear from primary care: are multiple interventions better than one alone?
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Improving referrals for glue ear from primary care: are multiple interventions better than one alone?

机译：改善初级保健对胶耳的转诊：多种干预是否比单独干预更好？

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Objectives: To evaluate the effect of a risk factor checklist and training video for general practitioners in reducingninter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value ornPPV) of patients with suspected otitis media with effusion (OME or ‘glue ear’) to secondary care.nMethods: Fifty general practices (177 practitioners) from the NHS Trent region and the West of Scotland werencluster-randomised either to a control group (n=12) or to one of three intervention groups (training video (n=16),nchecklist (n=11), or both (n=11)). Data on all paediatric ear, nose and throat (ENT) referrals and diagnostic results atnENT clinics were collected for a one-year period pre- and post-intervention. Referral rates for OME and for closelynrelated conditions were calculated for children aged 0–15 years, based on each practice’s list size. PPV was de. nednas the proportion of referrals resulting in bilateral hearing loss 520 dB at the ENT outpatient department.nResults: There was a signi. cant improvement in the PPV, adjusted for patients’ waiting time between generalnpractitioner (GP) referral and being seen at the ENT department. The improvement in PPV pre- and postinterventionnwas 15% (95% con. dence interval, CI: 712.1% to 41.7%) for the practices receiving bothninterventions, compared with a degradation of 20% pre- and post-intervention (95% CI: 732.9% to 76.4%) fornpractices receiving only one intervention and a degradation of 34% for those receiving no intervention.nConclusions: Disseminating a risk factor checklist and training video on glue ear to GPs using a multi-channelnapproach can improve the quality of referrals to ENT.
机译：目的：评估风险因素检查表和培训视频对全科医生减少疑似中耳炎积液（OME或'胶水）患者的内科差异和改善转诊的适当性（通过其阳性预测值ornPPV进行评估）方法：将来自NHS特伦特地区和苏格兰西部的50名普通医生（177名从业人员）随机分为对照组（n = 12）或三个干预组之一（培训视频（ n = 16），nchecklist（n = 11）或两者（n = 11））。在干预前后一年的时间内，收集了所有儿科耳，鼻，喉（ENT）转诊和诊断结果的数据。根据每种做法的清单大小，计算了0-15岁儿童的OME和密切相关疾病的推荐率。 PPV为de。耳鼻喉科门诊的转诊比例导致双耳听力损失520dB。n结果：有显着性。 PPV不能改善，但要根据患者在全科医生转诊至耳鼻喉科之间的等待时间进行调整。既接受干预又接受干预的做法，干预前后PPV的改善为15％（置信区间为95％，置信区间：712.1％至41.7％），而干预前后的降幅为20％（置信区间为95％： 732.9％到76.4％）的干预措施仅接受一项干预措施，而未接受干预措施的则降低了34％。耳鼻喉科。

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