Mazza D, Russell S J
Royal Australian College of General Practitioners, Victoria.
Aust Fam Physician. 2001 Aug;30(8):817-21.
The aim of this study was to investigate aspects of general practitioners' current use of clinical practice guidelines (CPGs) in daily general practice.
Face to face, semistructured interviews.
General practices in rural and metropolitan Australia.
25 GPs.
General practitioners' knowledge about CPGs; their recent use and reasons for using them; how GPs used them; where they stored them and which attributes of CPGs they considered to be most, and least, useful.
Each GP interviewed was able to name at least one 'guideline' that they knew about. The most commonly used was a therapeutic guideline with 'prescribing' being the most common reason for accessing a guideline. Most GPs stored guidelines in their consulting room, reading them when they felt they needed to; some also used them during the consultation and showed them to patients. General practitioners used CPGs to assist in making therapeutic decisions more frequently than when deciding when and whether to implement preventive measures.
The main finding from this study is that GPs are not in the main following, or accessing, the CPGs that have been developed. Strategies are required to create a culture in which evidence based guidelines are used and valued within general practice. Such a culture in which the processes of development, dissemination, implementation and evaluation of CPGs are well established, may take 5-10 years to achieve.
本研究旨在调查全科医生在日常全科医疗中当前使用临床实践指南(CPGs)的情况。
面对面的半结构化访谈。
澳大利亚农村和大都市的全科医疗诊所。
25名全科医生。
全科医生对CPGs的了解;他们近期的使用情况及使用原因;全科医生如何使用CPGs;他们将CPGs存放在何处以及他们认为CPGs最有用和最没用的属性。
接受访谈的每位全科医生都能说出至少一条他们知道的“指南”。最常用的是治疗指南,“开处方”是查阅指南最常见的原因。大多数全科医生将指南存放在诊疗室,在他们觉得需要时阅读;一些人在诊疗过程中也会使用并向患者展示。与决定何时以及是否实施预防措施相比,全科医生更频繁地使用CPGs来协助做出治疗决策。
本研究的主要发现是,全科医生主要没有遵循或查阅已制定的CPGs。需要制定策略来营造一种在全科医疗中使用和重视循证指南的文化。要建立这样一种文化,即CPGs的制定、传播、实施和评估过程都已完善,可能需要5至10年时间才能实现。