以綜合分析法量化臨床作業系統和衛生教育介入方案對影響預防保健服務提供的成效

Effects of Office System and Educational Interventions in Increasing the Delivery of Preventive Health Services: A Meta-Analysis

10.6288/TJPH2002-21-01-05

郭鐘隆(Jong-Long Guo)；Nell H. Gottlied；黃久美(Chiu-Mieh Huang)

綜合分析 ； 預防保健服務 ； 臨床作業系統 ； 衛生教育介入 ； meta-analysis ； preventive health services ； office system ； educational intervention.

台灣公共衛生雜誌

21卷1期（2002 / 02 / 01）

36 - 51

繁體中文

目標：利用綜合分析法量化臨床作業系統和衛生教育介入方案影響預防保健服務的成效。方法：首先以設定之關鍵字在MEDLINE, HEALTH STAR, CINALE, DISSERTATION ABSTRACTS, ERIC和 PSYCH INFO等資料庫中，以四個標準對相關文獻進行篩選：1.發表於1990年代；2.統計結果可以計算成效值；3.包含一或多個預防保健服務項目；4.有實施臨床作業系統或衛生教育介入方案。結果：綜合分析後發現，不同的臨床作業系統和衛生教育介入方案對所研究的預防保健服務項目皆有正向的校果。對於「健康諮詢」和「預防接種」兩項的效果為中等強度，其成效值界於0.45至0.64及0.50之間。對於「預防性篩檢」的效果較低，其成效值界於0.07至0.22之間。就介入期程而言，以介入七個月至一年者有最好的成效值。就臨床作業系統或介入方案而言，指導醫師對實習醫師的個案監督與直接回饋的介入效果最好。對「健康諮詢」和「預防接種」而言，三種以上的介入比單一或兩種介入的效果為佳。對「預防性篩檢」和「健康諮詢」而言，針對病人設計的介入比針對醫師設計的介入成效佳。結論：臨床作業系統與衛生教育方案對於提昇預防保健服務的利用率有顯著的成效可獲證實。本研究的結果可供有意推廣預防保健服務的公共衛生計畫參考。

Objectives: To examine quantitative effect of office system and educational intervention in selected preventive health services (PHS) in primary care practices and whether effectiveness differed by study and intervention characteristics. Methods: Fifty studies that conducted office based interventions for improving PHS were retrieved from various computerized databases. Selected studies were based on the following criteria: (I) published since 1990, (2) contain results on the practices of primary care providers allowing calculation of at least one effect size, (3) data related to one or more of the following classifications of preventive health services: screening, lifestyle counseling and adult immunization, and (4) use office system tools or educational components. Results: There were small to medium effects for office system and educational interventions focusing on life style counseling (effect sizes range from 0.45 to 0.64, P＜0.0001) and adult immunizations (effect sizes range from 0.26 to 0.50, P＜0.0001). However, interventions produced smal1er effects for screening tests (effect sizes range from 0.07 to 0.22). Greater success was found for studies lasting 7 to 12 months and using chart audit measurement regardless of the type of preventive health service. With the exception of screening tests, delivery rates improved most when the subjects were the targets of a combination of three or more interventions. Interventions targeting patients were more successful than those targeting providers for screening tests and lifest~1e counse1ing. Conclusions: The effectiveness of office system and educational interventions for improving delivery rates is well-supported, especially for lifestyle counseling and adult immunizations.

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