背景:潜在的不适当的药物处方和低价值的诊断测试对患者安全构成风险,并增加卫生系统成本。通过我的健康记录使用和全科医学研究中的教育进行临床和医疗保健改进的目的是评估可扩展的在线质量改进干预措施。整合关于全国共享电子健康记录和合理处方的在线教育,病理和影像学由澳大利亚全科医生(GP)订购。
方法:该研究是一项平行的三臂随机试验,包括处方教育组,病理教育臂和影像教育臂。目前在澳大利亚执业的全科医生有资格参加,并在同意后以1:1:1的方式随机分配给研究组。使用其他两个手臂作为对照,评估了干预措施在减少每个手臂中潜在不必要的药物处方和测试方面的反应。主要结果是预定义药物处方的每100次咨询的费用,在干预后6个月订购病理和放射学测试,与前6个月相比。使用多水平回归模型在意向治疗和事后方案基础上评估结果,分析师对分配视而不见。
结果:总计,纳入106个GP并随机分组(处方n=35,病理学n=36,影像学n=35)。在试验结束时,有97名GPs的数据可用(处方n=33,病理学n=32,影像学n=32),其中44名完全完成了干预。在意向治疗分析中,这三个分支的成本变化率没有显著差异.根据协议,病理成本的变化率在统计学上有显著差异(p=0.03).在病理学领域,病理费用的增长率显著低于处方臂$A187(95%CI-$A340,-$A33),和非显著$A9(95%CI-$A128,$A110)低于成像臂。
结论:这项研究提供了一些证据,证明在完成相关网络教育的人中,低价值病理测试订购的成本降低。在COVID-19大流行期间,该研究的教育干预措施吸收缓慢,完成度低。主要终点的变化不显著,其中包括所有参与者。提高完成率并结合处方或测试顺序的实时反馈可以提高干预的整体有效性。鉴于纯粹的在线教育,有扩大干预范围的空间,这可能会提供成本效益的好处。
背景:ACTRN12620000010998。
Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice study was to evaluate a scalable online quality improvement intervention, integrating online education regarding a national shared electronic health record and rational prescribing, pathology and imaging ordering by Australian general practitioners (GPs).
The study was a parallel three-arm randomised trial comprising a prescribing education arm, a pathology education arm and an imaging education arm. Currently practising GPs in Australia were eligible to participate and randomised on a 1:1:1 basis to the study arms after consenting. The response to the intervention in reducing potentially unnecessary medicine prescriptions and tests in each arm was assessed using the other two arms as controls. The primary outcome was the cost per 100 consultations of predefined medication prescriptions, pathology and radiology test ordering 6 months following the intervention, compared with 6 months prior. Outcomes were assessed on intention-to-treat and post hoc per-protocol bases using multilevel regression models, with the analysts blinded to allocation.
In total, 106 GPs were enrolled and randomised (prescribing n=35, pathology n=36, imaging n=35). Data were available for 97 GPs at the end of trial (prescribing n=33, pathology n=32, imaging n=32) with 44 fully completing the intervention. In intention-to-treat analysis, there were no significant differences in the rates of change in costs across the three arms. Per protocol, there was a statistically significant difference in the rate of change in pathology costs (p=0.03). In the pathology arm, the rate of increase in pathology costs was significantly lower by $A187 (95% CI -$A340, -$A33) than the prescribing arm, and non-significantly $A9 (95% CI -$A128, $A110) lower than the imaging arm.
This study provides some evidence for reductions in costs for low-value pathology test ordering in those that completed the relevant online education. The study experienced slow uptake and low completion of the education intervention during the COVID-19 pandemic. Changes were not significant for the primary endpoint, which included all participants. Improving completion rates and combining real-time feedback on prescribing or test ordering may increase the overall effectiveness of the intervention. Given the purely online delivery of the education, there is scope for upscaling the intervention, which may provide cost-effectiveness benefits.
ACTRN12620000010998.