Providing patients with reviews of evidence about COPD treatments: a controlled trial of outcomes

Studies in many countries have identified gaps between what is known from research evidence and what is done in clinical practice. Merely making research evidence available to practitioners does not cause much change in their behaviour, and researchers are now looking for more effective ways to improve the implementation of evidence. We report outcomes at three months of a parallel group trial of an evidence based patient manual designed to improve implementation of evidence by the patient’s doctors. The patient manual was produced with extensive patient and professional input. It contained summaries of the evidence for treatments used in COPD (chronic obstructive pulmonary disease) and prompted discussion of evidence with doctors. Participants in the intervention arm of the trial (n - 125) were supplied with the manual and participants in the control arm (n - 124) were supplied with a pamphlet about COPD produced by the Australian Lung Foundation. The primary outcome measure (rates of current influenza vaccination and bone density testing) was an indicator of evidence based management of COPD. Secondary outcomes were quality of life (mastery component), satisfaction with information, communication with usual doctor, and anxiety. At three months no pattern of benefit in outcome measures was found for either group. Process measures showed high levels of personal use of the manual but progression to conversations with doctors for fewer than half of participants, and little treatment change. The findings highlight the difficulties of promoting changes in health behaviour and show that even when all stakeholders are consulted success is not guaranteed. Further research is required to identify those patients most likely to use manuals such as the one reported here, and how to make patient mediated interventions more effective for a greater proportion of the target population.

许多国家的研究都发现了研究证据所表明的情况与临床实践之间存在差距。仅仅向从业者提供研究证据并不会使他们的行为发生太大改变，因此研究人员现在正在寻找更有效的方法来改善证据的应用。我们报告了一项平行组试验三个月的结果，该试验使用了一本基于证据的患者手册，旨在改善患者医生对证据的应用。该患者手册是在广泛征求患者和专业人士意见的基础上编写的。它包含了慢性阻塞性肺疾病（COPD）治疗证据的摘要，并促使患者与医生讨论相关证据。试验干预组的参与者（n = 125）得到了该手册，对照组的参与者（n = 124）则得到了一本由澳大利亚肺脏基金会编写的关于COPD的小册子。主要结果指标（当前流感疫苗接种率和骨密度检测率）是慢性阻塞性肺疾病基于证据的管理的一个指标。次要结果包括生活质量（掌控部分）、对信息的满意度、与日常医生的沟通以及焦虑情况。三个月时，两组在结果指标上均未发现有益的模式。过程指标显示，手册的个人使用率较高，但只有不到一半的参与者与医生进行了相关交谈，而且治疗变化很小。这些研究结果凸显了促进健康行为改变的困难，并表明即使咨询了所有利益相关者，也不能保证成功。需要进一步的研究来确定哪些患者最有可能使用像这里所报告的这种手册，以及如何使以患者为媒介的干预措施对更大比例的目标人群更有效。