Comparative trial of a short workshop designed to enhance appropriate use of screening tests by family physicians

BACKGROUND: Educational interventions that support the implementation of complex clinical practice guidelines (CPGs) require substantial time commitments from participants. We conducted a comparative study to evaluate if a 90-minute workshop would increase compliance with the recommendations of the Canadian Task Force on Preventive Health Care as well as decrease the ordering of tests not the subject of specific recommendations. METHODS: Eighty-seven family physicians from Quebec participated in the study. Group assignment was initially randomized, but, owing to logistic problems, randomization was not maintained. After unannounced visits, 2 standardized patients coded the physicians' performance of 23 items recommended for inclusion in the periodic health examination (10 for men and 13 for women) and 8 items recommended for exclusion (4 for both men and women). The “exposed” physicians were visited within 4 to 6 months after the workshop. The “nonexposed” physicians were visited within 4 to 6 months after consent was obtained but before they attended the workshop. We used linear regression analysis to determine if exposure to the workshop resulted in improved performance. RESULTS: Exposure to the workshop was not associated with a difference in the adjusted mean score for items recommended for inclusion (12.07 for exposed physicians v. 12.35 for those not exposed; maximal and ideal score 23; r = –0.28; 95% confidence interval [CI] = –1.63 to 1.08). However, workshop exposure was associated with lower adjusted mean scores for items recommended for exclusion (1.55 v. 3.17; maximal score 8, ideal score 0; r = –1.63; 95% CI = –2.50 to –0.75) and for other tests (3.59 v. 6.53; r = –2.95; 95% CI = –5.10 to –0.79). INTERPRETATION: A short workshop can decrease the ordering of unnecessary screening tests by family physicians. Given its low cost and its potential for general application, such an intervention can support the implementation of prevention CPGs.

研究背景：支持复杂临床实践指南（Clinical Practice Guidelines, CPGs）落地的教育干预措施，往往需要参与者投入大量时间。本研究开展对比试验，旨在评估时长90分钟的工作坊能否提升医护人员对加拿大预防保健工作组（Canadian Task Force on Preventive Health Care）推荐方案的依从性，并减少未被纳入特定推荐范围的检验项目开具量。
研究方法：本次研究共招募87名来自魁北克省的家庭医生。研究初始采用随机分组，但因后勤问题未能维持随机分组方案。在非预先通知的访视后，由2名标准化患者（standardized patients）对家庭医生的诊疗操作进行评分记录，评分涵盖23项需纳入定期健康检查的推荐项目（男性10项，女性13项）以及8项需排除的推荐项目（男女各4项）。干预组医生在参加工作坊后4至6个月内接受访视，对照组医生则在签署知情同意后、参加工作坊前的4至6个月内接受访视。本研究采用线性回归分析，以评估参与工作坊是否能提升医生的诊疗操作表现。
研究结果：参与工作坊与需纳入项目的校正后平均分差异无统计学意义（干预组医生得分为12.07，对照组为12.35；满分及理想分值均为23；r=-0.28；95%置信区间（Confidence Interval, CI）：-1.63~1.08）。但参与工作坊与需排除项目的校正后平均分降低相关（干预组为1.55，对照组为3.17；满分8分，理想分值0分；r=-1.63；95%CI：-2.50~-0.75），同时与其他检验项目的校正后平均分降低相关（干预组3.59，对照组6.53；r=-2.95；95%CI：-5.10~-0.79）。
研究解读：简短的工作坊即可降低家庭医生不必要的筛查检验项目开具量。鉴于该干预措施成本低廉且具备广泛推广潜力，其可有效助力预防类临床实践指南的落地实施。