哮喘联盟

   摘要
   背景：哮喘的护理质量仍然不理想，对指南的依从性仍然较低，提高对指南的依从性会提高护理的质量。我们进行了一项试验，以确定成组自我评估模块（SAM）的活动是否会增加对哮喘指南的了解和依从性，成组自我评估模块是由促进者组织并作为家庭医生认证维护（MC-FP）的一部分来执行的。
   方法：参与的医师在一组SAM进行前和结束6个月后，完成哮喘患者的图表审核。在一组SAM进行前、立即结束时和6个月后调查医师对哮喘指南的了解程度。研究在SAM进行前和结束后，使用χ(2) 和t检验检测医师对哮喘指南了解程度和对指南依从性方面的差异。
   结果:弗吉尼亚州的38例医师完成SAM，并有完整的数据。参与者完成的MC-FP活动比其他医师更多，但其他特征都具有可比性。除对持续性哮喘患者处方控制药物方面外，完成SAM组6个月后其他所有质量措施显著提高。通过严重程度诊断比例从48.3%提高到80.2%，行动计划的使用比例从8.1%上升到54.1%。医师对指南的了解程度在完成SAM后立即有所改善，并持续6个月。不断增加的知识转化为临床技能：30%的参与者完成SAM后对评价控制报告舒适，在SAM结束后6个月，报告舒适的比例增加至97.5%。
   结论:SAM组块可能是可以提高医师对临床指南的了解程度和依从性的一种有效方法。
 

（林江涛 审校）
J Am Board Fam Med. 2014 May-Jun;27(3):391-8. doi: 10.3122/jabfm.2014.03.130241.

 

Improving quality of care and guideline adherence for asthma through a group self-assessment module.
 

Elward K1, Blackburn B, Peterson LE, Greenawald M, Hagen MD.
 

ABSTRACT
BACKGROUND: The quality of care for asthma remains suboptimal. Compliance with guidelines remains low, but improved adherence to guidelines may increase the quality of care. but. We conducted a trial to determine whether group Self-Assessment Module (SAM) activities led by a facilitator and conducted as part of Maintenance of Certification for Family Physicians (MC-FP) would increase knowledge of and adherence to asthma guidelines.
METHODS: Participating physicians completed audits of the charts of patients with asthma before and 6 months after a group SAM. Surveys of physicians' knowledge of asthma guidelines were administered immediately before, immediately after, and 6 months after the group SAM. We tested for differences in knowledge of and adherence to guidelines before and after the SAM using χ(2) and t tests.
RESULTS: Thirty-eight physicians in Virginia completed the SAM and had complete data. Participants completed more MC-FP activities than other physicians but were comparable in other characteristics. Except for prescribing controller medications for persistent asthma, all other quality measures significantly improved 6 months after the group SAM. Diagnosis by severity improved from 48.3% to 80.2%, and the use of action plans increased from 8.1% to 54.1%. Physicians' knowledge of guidelines improved immediately after the SAM and was sustained at 6 months. Increased knowledge translated into clinical skills: 30% of participants reported comfort with assessing control after the SAM, which increased to 97.5% 6 months after the SAM.
CONCLUSIONS: Group SAMs may be an effective method to increase physicians' knowledge of and adherence to clinical guidelines.
 

J Am Board Fam Med. 2014 May-Jun;27(3):391-8. doi: 10.3122/jabfm.2014.03.130241.