Stoevelaar H J, McDonnell J, van de Beek C, Casparie A F
Erasmus Universiteit, Instituut Beleid en Management Gezondheidszorg, Rotterdam.
Ned Tijdschr Geneeskd. 1999 Nov 27;143(48):2425-9.
To assess systematically the opinion of urology experts regarding the appropriateness of indications for treatment of benign prostatic hyperplasia (BPH) and to evaluate the potential use of these expert opinions for the refinement of treatment guidelines.
Modified Delphi procedure.
A panel of 12 Dutch urologists judged the appropriateness of three common treatments (surgery, alpha-adrenergic antagonists, finasteride) for 1152 hypothetical cases of BPH. These cases consisted of all combinations of 9 diagnostic characteristics considered relevant to treatment choice. The study population was restricted to patients for whom current (evidence-based) guidelines do not provide clear indications on the most appropriate treatment. The panel members individually rated the appropriateness of the three active treatments using a 1 to 9 scale, each in comparison with 'watchful waiting'. By combining the results on agreement and appropriateness, aggregate panel judgements were calculated for each indication (appropriate, inappropriate, uncertain). The relationship between diagnostic characteristics and panel opinions was studied using logistic regression methods.
For patients without previous treatment for BPH, surgery was considered appropriate in 44% of cases. For alpha-blocking drugs and finasteride, these values were 70% and 3% respectively. Logistic regression analysis revealed a strong and consistent relationship between the several diagnostic characteristics and the panel judgement 'appropriate indication'.
Systematic analysis of clinical expertise can offer a meaningful contribution to the refinement of indications for BPH treatments.
系统评估泌尿外科专家对良性前列腺增生（BPH）治疗指征适宜性的看法，并评估这些专家意见在完善治疗指南方面的潜在用途。
改良德尔菲法。
一个由12名荷兰泌尿外科医生组成的小组对1152例假设的BPH病例的三种常见治疗方法（手术、α-肾上腺素能拮抗剂、非那雄胺）的适宜性进行了判断。这些病例由9种与治疗选择相关的诊断特征的所有组合构成。研究人群仅限于当前（循证）指南未就最合适治疗提供明确指征的患者。小组成员使用1至9分的量表分别对三种积极治疗方法与“观察等待”相比的适宜性进行评分。通过综合一致性和适宜性结果，计算每个指征的小组总体判断（适宜、不适宜、不确定）。使用逻辑回归方法研究诊断特征与小组意见之间的关系。
对于未曾接受过BPH治疗的患者，44%的病例中手术被认为是适宜的。对于α-阻滞剂和非那雄胺，这些比例分别为70%和3%。逻辑回归分析显示，几种诊断特征与小组判断“适宜指征”之间存在强烈且一致的关系。
对临床专业知识的系统分析可为完善BPH治疗指征做出有意义的贡献。
