Jans M P, Schellevis F G, van Hensbergen W, Dukkers van Emden T, van Eijk J T
Institute for Research in Extramural Medicine, Amsterdam, The Netherlands.
Int J Qual Health Care. 1998 Feb;10(1):27-34. doi: 10.1093/intqhc/10.1.27.
To examine the feasibility of the application of guidelines to the management of asthma and chronic obstructive pulmonary disease (COPD) by assessing compliance with the guidelines and listing the barriers general practitioners (GPs) encountered during implementation. Insight into the feasibility of individual items in the guidelines can guide implementation strategies in the future and, if necessary, support revision of the guidelines.
Descriptive study of care delivered during the implementation of guidelines by means of documentation of the care provided, education, feedback on compliance and peer review.
General practice.
Sixteen GPs in 14 general practices.
Compliance was expressed as the percentage of patients per practice managed by the GPs according to the guidelines. For each patient (n=413) data were collected on the care delivered during the first year of the implementation. Barriers encountered were derived from the summaries of the discussions held during the monthly meetings.
The GPs were most compliant on the items 'PEFR measurement at every consultation' (98%), 'allergy test' (78%) and 'advice to stop smoking' (82%), and less compliant on the items 'four or more consultations a year' (46%), 'ordering spirometry' (33%), 'adjustment of medication' (42%), 'check on inhalation technique' (38%) and referral to a chest physician (17%) or a district nurse (5%). The main barriers were the amount of time to be invested, doubts about the necessity of regular consultations and about the indications for ordering spirometry and for referral to a chest physician or a district nurse.
Although the feasibility was assessed in a fairly optimal situation, compliance with the guidelines was not maximal, and differed between the individual items of care. Suggestions are given for further improvements in compliance with the guidelines and for revision of the guidelines.
通过评估指南的依从性并列出全科医生（GP）在实施过程中遇到的障碍，探讨将指南应用于哮喘和慢性阻塞性肺疾病（COPD）管理的可行性。深入了解指南中各个项目的可行性可以指导未来的实施策略，并在必要时支持指南的修订。
通过记录所提供的护理、教育、依从性反馈和同行评审，对指南实施过程中提供的护理进行描述性研究。
全科医疗。
14家全科诊所的16名全科医生。
依从性以每家诊所中按照指南由全科医生管理的患者百分比表示。对于每位患者（n = 413），收集了实施第一年期间提供的护理数据。遇到的障碍来自每月会议期间讨论的总结。
全科医生在“每次会诊时进行呼气峰流速（PEFR）测量”（98%）、“过敏测试”（78%）和“戒烟建议”（82%）这些项目上的依从性最高，而在“每年进行四次或更多次会诊”（46%）、“安排肺功能测定”（3(3%)、“调整药物”（42%）、“检查吸入技术”（38%）以及转诊至胸科医生（17%）或社区护士（5%）这些项目上的依从性较低。主要障碍包括需要投入的时间量、对定期会诊必要性的怀疑以及对安排肺功能测定和转诊至胸科医生或社区护士的指征的怀疑。
尽管在相当理想的情况下评估了可行性，但对指南的依从性并非最高，且不同护理项目之间存在差异。针对进一步提高指南依从性和修订指南给出了建议。
