Sponsored Health IT and Evidence-Based Prescribing among Medical Residents

赞助住院医生的健康信息技术和循证处方

• 批准号: 8680863
• 负责人: Brian A. Primack
• 金额: $ 15万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8680863
• 关键词: Sponsored; Health; Evidence; Based; Prescribing

DESCRIPTION (provided by applicant): A substantial proportion of prescriptions written by physicians are not evidence based, which can result in drug abuse and misuse, increased morbidity and mortality, and rising health care costs. Although a variety of factors can influence physician prescribing, sponsored messaging by industry such as pharmaceutical companies has been shown to lead to non-evidence-based prescribing (non-EBP). As the healthcare industry has embraced health information technology (HIT) and physicians have increased their use of smartphones and tablets with point-of-care decision-making with their patients, sponsored messaging has begun to penetrate physicians' HIT environment. Because this form of targeted marketing by pharmaceutical companies is relatively new and not completely understood, we need to examine its relationships with the factors (system-level, physician-level and patient-level) that have been known to lead to non-EBP. Additionally, training programs are needed to reaffirm the basic principles of EBP in the presence of sponsored messaging in physicians' health IT environment. Thus, we have developed a Web-based HIT intervention, titled SMARxT, rooted in the tenets of media literacy and targeted at physicians-in-training (residents), in order to teach them how to effectively navigate their HIT environment and counteract sponsored messaging. In order to determine the preliminary efficacy, feasibility and acceptability of SMARxT for residency programs, this HIT intervention needs to be pilot tested and evaluated with a group of residents, described in this application. First, we will conduct a pilot test and process evaluation of the SMARxT program health IT intervention. Sixty family medicine and internal medicine residents from local training programs will be recruited to participate in the intervention and complete quantitative and qualitative assessments immediately after completion and 6 months later. These assessments will measure the residents' perceptions of feasibility and acceptability of the intervention. Additionally, specific process evaluation metrics will assess the implementation fidelity of the intervention. Second, the same 60 residents will participate in an outcome evaluation of the SMARxT program health IT intervention. This evaluation will be conducted concurrently with the process evaluation. A time-series quasi- experimental design-pre-test (T1), post-test (T2), and follow-up (T3)-will be employed, during which all residents will be asked to complete quantitative assessments. These assessments will measure the preliminary efficacy of the intervention in addressing the residents' knowledge and attitudes towards EBP as well as likely EBP behavior. The results from the pilot test and evaluation of the SMARxT program will allow us to make modifications and take steps to implement the program in other residency programs nationwide.

描述（由申请人提供）：医生开具的处方中很大一部分没有证据依据，这可能导致药物滥用和误用、发病率和死亡率增加以及医疗保健成本上升。尽管有多种因素会影响医生的处方，但制药公司等行业赞助的信息已被证明会导致非循证处方（非 EBP）。随着医疗保健行业开始采用健康信息技术 (HIT)，并且医生越来越多地使用智能手机和平板电脑来为患者做出即时护理决策，赞助消息已开始渗透到医生的 HIT 环境中。由于制药公司的这种定向营销形式相对较新且尚未完全被理解，因此我们需要检查其与已知导致非 EBP 的因素（系统层面、医生层面和患者层面）的关系。此外，需要开展培训计划，以在医生的健康 IT 环境中存在赞助消息的情况下重申 EBP 的基本原则。因此，我们开发了一种基于网络的 HIT 干预措施，名为 SMARxT，植根于媒体素养的原则，并针对实习医生（住院医师），以教他们如何有效地驾驭 HIT 环境并抵制赞助消息。为了确定 SMARxT 用于住院医师计划的初步功效、可行性和可接受性，需要对本申请中描述的一组住院医师进行试点测试和评估。首先，我们将对 SMARxT 计划健康 IT 干预进行试点测试和过程评估。将从当地培训项目中招募60名家庭医学和内科住院医师参与干预，并在完成后立即和6个月后完成定量和定性评估。这些评估将衡量居民对干预措施的可行性和可接受性的看法。另外，具体 过程评估指标将评估干预措施的实施保真度。其次，同样的 60 名居民将参与 SMARxT 计划健康 IT 干预的结果评估。该评估将与过程评估同时进行。将采用时间序列准实验设计——前测（T1）、后测（T2）和随访（T3）——在此期间，所有居民将被要求完成定量评估。这些评估将衡量干预措施在解决居民对 EBP 的知识和态度以及可能的 EBP 行为方面的初步效果。 SMARxT 项目的试点和评估结果将使我们能够做出修改并采取措施在全国其他住院项目中实施该项目。