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目的指南建议对患者的不健康行为方式和心理健康情况进行筛查。健康风险评估能对患者的需求和提供的照顾做系统识别。研究将对此类评估能否在日常工作中付诸实施做出评价。方法作为群组随机实用试验的一部分,有9家初级保健诊所完成了自我健康报告(my own health report,MOHR)电子版或纸质版健康行为和心理健康评估及咨询和目标配对反馈系统。研究者观察的内容包括:诊所如何将MOHR融入他们的工作流、完成评估工作人员所需的时间、患者完成MOHR评估的百分率(完成率)。结果大多数诊所(60%)同意施用MOHR。如何完成MOHR筛查还要依赖于诊所的资源条件、信息系统能力及患者特性。3家诊所用邮件邀请患者在网络上完成MOHR;1家诊所通过电话完成MOHR;1家诊所邀请患者在诊所内完成MOHR;4家诊所医务人员通过网络协助患者完成MOHR。总体上,纳入研究的3 591例患者中有1 782例患者完成MOHR,完成率为49.6%。实施策略导致完成率不同,由医务人员协助比患者自己答卷的完成率要高(71.2%比30.2%,P<0.001)。研究完成后,由于未加以推广施用,没有诊所能坚持做MOHR评估。填写MOHR,增加了工作人员和临床医生的工作时间,每例平均增加28 min。结论初级保健诊所能够完成健康行为和心理健康评估,但还需为提供有效的咨询做出努力。诊所还需更多的帮助,以确保筛查的实施与保持。
Purpose The guidelines recommend screening patients for unhealthy behaviors and mental health. Health risk assessment can systematically identify patient needs and care provided. The study will evaluate whether such assessments can be implemented in their daily work. Methods Nine primary care clinics completed an electronic or paper-based health behavioral and mental health assessment and counseling and targeted pairing feedback system for their own health report (MOHR) as part of a randomized, practical trial of groups. The researchers looked at how clinics incorporated MOHR into their workflows, how long it took to complete staff assessment, and how percentage of patients completed MOHR assessments (completion rates). Results Most clinics (60%) agreed to administer MOHR. How to complete MOHR screening also depends on the clinic’s resource conditions, information system capabilities, and patient characteristics. Three clinics invites patients to complete MOHR on the network by mail; one clinic completes the MOHR by phone; one clinic invites patients to complete MOHR at the clinic; and four clinic medical staff assist patients in completing MOHR through the Internet. Overall, 1 782 of the 3 591 patients included in the study completed MOHR with a completion rate of 49.6%. Implementation strategies resulted in different rates of completion, with a higher rate of completion by medical staff than patients’ own responses (71.2% vs. 30.2%, P <0.001). After the study was completed, no clinics were able to adhere to the MOHR assessment because they were not promoted. Filling in the MOHR increased the working hours of staff and clinicians, with an average increase of 28 min per case. Conclusions Primary care clinics can perform health behavioral and mental health assessments, but efforts are also needed to provide effective counseling. Clinic needs more help to ensure the implementation and maintenance of screening.