全科医学相关指南的开发、实施及应用效果  

Development,Application and Effectiveness of Clinical Guidelines in General Practice

作　　者：杨辉 许岩丽 叶志康 YANG Hui;XU Yanli;YE Zhikang(Monash University,Melbourne 3168,Australia;Publishing House of Journal of Chinese General Practice,Beijing 100053,China;Michael G.DeGroote National Pain Centre,McMaster University,Hamilton L8N 3Z5,Canada;McMaster GRADE Center,McMaster University,Hamilton L8N 3Z5,Canada)

机构地区：[1]Monash University,Melbourne 3168,Australia [2]中国全科医学杂志社,北京市100053 [3]Michael G.DeGroote National Pain Centre,McMaster University,Hamilton L8N 3Z5,Canada [4]McMaster GRADE Center,McMaster University,Hamilton L8N 3Z5,Canada

出　　处：《中国全科医学》2023年第1期1-10,共10页Chinese General Practice

摘　　要：背景 循证临床服务指南是促进全科医学提供高质和有效服务的重要资源。目前,对全科医学相关指南研发、实施和评价的研究尚不足。目的 了解国际上全科医学相关指南的研发和使用情况,为我国全科医学相关指南的开发和应用研究提供借鉴。方法 于2022年8—9月,系统检索PubMed数据库,以获取与全科相关指南开发、实施及应用相关的文献。文献语种限定为英文,发表时间限定为2012-01-01至2022-09-07。提取纳入文献的作者信息、期刊信息、研究问题等,对全科医学相关指南的开发、分发和实施的影响因素、应用效果3个方面进行综述。结果 (1)针对全科医学相关指南的研究涉及包括中国在内的多个国家,包括定量研究、质性研究、文献分析、理论探讨等。(2)全科医生组织和全科研究者主持/参与指南研发,可以提高指南的被接受度和背景化程度,并有利于将医生经验、患者偏好等信息融入指南。全科共识是一种适宜的指南形式,转诊建议是指南的关键内容之一。指南分析和改编可用于全科医生培养。(3)全科医学相关指南的实施受到比专科指南更多因素的影响。开展以问题为导向的、符合自导学习的指南培训,对指南遵从率有积极影响。临床审计和循证医学俱乐部是常用且有效的促进指南实施的做法,全科医生对指南的反馈有助于指南的持续改进。(4)全科医学相关指南对医生诊疗行为的影响是可以观察到的,指南对患者健康结果的影响则需要更缜密和复杂的研究设计。结论 全科医生参与指南的开发、实施和评价,是全科循证医学的发展方向。全科医生的经验和人文精神、患者偏好和期望、影响指南实施的全科领域内和领域外因素,都需要通过与方法学专家合作被纳入全科临床指南的研发、实施和评价中。Background Evidence-based clinical guidelines are important resources for promoting the provision of high-quality and effective general practice services.Research on the development,application and effectiveness evaluation of guidelines in general practice is insufficient.Objective To understand the development and application of international guidelines in general practice,informing the development and utilization of relevant guidelines in China.Methods The PubMed database was systematically searched from August to September 2022 for studies in English related to the development,application and effectiveness of guidelines in general practice published during January 1,2012 to September 7,2022.The author information and focused issues as well as publication journals of the studies were extracted.And associated factors of the development,distribution and use,and effectiveness of guidelines were reviewed.Results (1)A number of countries,including China,conducted the research using quantitative,qualitative,literature review and theoretical methods.(2)Organisations of general practitioners(GPs) and researchers in general practice leading or participating in guideline development,can improve the guideline acceptability and applicability,and the integration of physician experiences and patient preferences in shaping the guideline.General practice consensus is an appropriate type of the guideline.Referral recommendation is one key component of the guidelines.Guideline analysis and adaptation can be used as a strategy for GPs training.(3)Compared with specialty guidelines,the application of guidelines in general practice has been affected by more factors.Problem-oriented and self-guided guideline trainings are beneficial to the improvement of guideline compliance.Clinical audits and evidence-based medicine journal clubs are common and effective approaches for promoting guideline implementation.GPs’ feedback on the guideline contributes to continuous improvement of the guidelines.(4)The impact of these guidelines on GPs

关 键 词：全科医学 循证医学 诊疗指南 指南制定 指南实施 指南评价 双向转诊 研究设计 综述 

分 类 号：R4[医药卫生—临床医学] R-05