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背景结直肠癌筛查的参与率低于被推荐的欧洲目标。目的评估初级护理中电子病历警报的有效性,即与常规护理相比,其增加个人参与有组织的、基于人群的结直肠癌筛查项目的效果。设计与地点西班牙巴塞罗那初级护理中心的整群随机对照试验。方法纳入50~59岁接受过免疫化学测试(FIT)的41 042例患者,以及他们的初级保健人员130例,对他们施盲。对照组进行常规初级保健,按照大肠癌筛查计划。干预组除常规护理外,在为期一年的初级护理中纳入健康专业人士建议的电子病历警报以促进筛查。主要观察结果为结直肠癌筛查的参与率和个人参与情况。结果干预组中67位医生和21 619例患者以及对照组中63位医生和19 423例患者是随机选取的。意向处理分析中两组筛查参与率分别为44.1%和42.2%[OR=1.08,95%CI(0.97,1.20),P=0.146]。但在调整潜在的混杂因素后,干预组筛查参与率明显升高[OR=1.11,95%CI(1.02,1.22),P=0.018]。结论在初级护理中,使用电子病历警报和参与初级护理对提升结直肠癌筛查参与率的显著提升密切相关。
Background Colorectal cancer screening has a lower participation rate than the recommended European target. PURPOSE To assess the effectiveness of EHR alerts in primary care by increasing individual participation in organized, population-based colorectal cancer screening programs as compared to routine care. Design and Location Cluster randomized controlled trial of primary care center in Barcelona, Spain. Methods 41 042 patients 50 to 59 years old with immunochemical test (FIT) and 130 primary care workers were enrolled in this study. The control group received routine primary care according to the colorectal cancer screening program. In addition to routine care, the intervention group included electronic medical record alerts recommended by health professionals in one-year primary care to facilitate screening. The main observation is the participation rate and individual participation in colorectal cancer screening. Results Sixty-three physicians and 21,619 patients in the intervention group and 63 42 patients in the control group were randomized. The intention-to-treat analysis was 44.1% and 42.2% for the two groups [OR = 1.08,95% CI (0.97,1.20), P = 0.146]. However, after adjusting for potential confounders, the screening participation rate in the intervention group was significantly increased [OR = 1.11, 95% CI (1.02, 1.22), P = 0.018]. Conclusion In primary care, the use of electronic medical records alerts and participation in primary care are significantly associated with a significant increase in screening participation in colorectal cancer screening.