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實證醫學教育訓練對醫院醫事人員實證醫學能力之成效評估

Effect of the Workshops and E-learning of Evidence-Based Medicine for Public Hospital Employees

摘要


目的:本研究目的在建構與評估線上及行動EBM學習平台,再經由實務工作坊的教育訓練,促成資源不足醫院醫事及醫師(尤其是PGY學員和年輕住院醫師)在應用EBM的態度和能力能夠正向提升,進而提升照護病人的品質。方法:本研究對象為衛生福利部所屬醫院醫師、護理及醫事人員,採用與台北醫學大學EBM中心共同完成之EBM認知、態度和能力評值工具,分析使用線上及行動EBM網路平台學習與EBM實務工作坊及研討會前、後之實證醫學能力改善成效;並分析各變項在群組間實證醫學能力之成效差異。結果:本研究完成前測問卷421人及後測問卷415人,完訪率為98.6%。結果顯示,後測評值不管是EBM五大能力評估的任一面向,幾乎所有的變項分群在訓練後,皆較前測有顯著進步;而在各變項分群的進步幅度分析,實證醫學五大能力之形成臨床問題部分,女性顯著優於男性(p<0.01)、不同職別的進步顯著不同(p<0.01);文獻評讀部分,女性優於男性(p<0.05)、不同年資的進步顯著不同(p<0.05)、前測前不知Cochrane有中文資料者進步較多(<0.01);臨床應用部分,不同職別的進步顯著不同(p<0.01);此外,不同等級醫院間在EBM五大面向之前、後測均有顯著進步,但醫院等級間的進步幅度並無顯著的差異。結論:透過實證醫學工作坊及EBM平台線上學習,所有醫事人員(尤其是女性、新進人員及原本較不熟悉EBM中文資料庫者)之實證醫學包括態度與能力,均有顯著進步,應持續推廣。

並列摘要


Objectives. The purpose of this study was to assess the improvements in Evidence-based medicine (EBM) hability and attitudes of public health employees attending EBM workshops and using EBM e-learning programs. Methods. All employees of hospitals affiliated with the Ministry of Health and Welfare were invited by e-mail to participate in the self-administered structured questionnaire survey on their attitudes towards EBM and their skill at incorporating it into their daily practice. A pre-test was administered from August through December, 2013, and a post-test from August through December, 2014. Results. In total, 421 subjects completed the pre-test questionnaire, and 415 subjects completed the post-test questionnaire (98.6%). Significant improvement was found in EBM skill level and attitudes toward EBM. Conclusion. Promoting the utilization of EBM databases, especially the Chinese database in the Cochrane Library, and encouraging participation in EBM workshops and e-learning programs may increase health care workers' ability to utilize data and findings reported by EBM. This should lead to improvements in quality of patient care.

參考文獻


賴慧仙、張正昂、李其融、陳杰峰、余光輝、李孟智(2015)。衛生福利部所屬醫院醫事人員實證醫學的能力與態度調查。醫學與健康期刊。5,45-56。
實證醫學知識網。http://imohw.tmu.edu.tw/引用日期2016/05/17。iMOHW. Available at: http://imohw.tmu.edu.tw/. Accessed May 17, 2016. [In Chinese]
Chiu, YW,Weng, YH,Lo, HL,Shih, YH,Hsu, CC,Kuo, KN(2010).Impact of a nationwide outreach program on the diffusion of evidence-based practice in Taiwan.International Journal for Quality in Health Care.22,430-6.
Cochrane, AL(1999).Effectiveness and Efficiency: Random Reflections on Health Services.London:Royal Society of Medicine Press.
DiCenso, A,Bayley, L,Haynes, RB(2009).Accessing preappraised evidence: fine-tuning the 5S model into a 6S model.ACP Journal Club.151,JC3-2-3.

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