Graham Ian D, Beardall Susan, Carter Anne O, Tetroe Jacqueline, Davies Barbara
Ottawa Health Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada.
J Eval Clin Pract. 2003 May;9(2):195-202. doi: 10.1046/j.1365-2753.2003.00385.x.
The Canadian Medical Association (CMA) maintains a database of clinical practice guidelines (CPGs) developed or endorsed by Canadian organizations. The study purpose was to describe how these guidelines were developed, disseminated and evaluated. A survey was mailed to the developer of each CPG registered in the CMA Infobase between June 1996 and December 1999. Data were received for 730 unique guidelines (response rate of 70%) developed by 75 organizations. Of these, 72% were developed by committees that had a formal process for selecting their members. The scientific literature was reviewed for all of the guidelines, a computerized search undertaken for 88% and the search strategy included 34% of CPG documents. An attempt was made to grade the quality of the evidence underpinning 54% of the guidelines. For most guidelines, consensus about values or judgements was reached by expert opinion through open discussion (78% of guidelines). The most common strategies used to disseminate the guidelines were direct mailing of guidelines to members of the developing organization (80% of all guidelines), publishing guidelines in newsletters/journals (76%), direct mailing to others (73%), electronic dissemination (62%), educational or continuing medical education activities (50%), and providing information about guidelines to patients/consumers (47%). Overall, 5% of the guidelines have been evaluated to determine their impact on health outcomes. During the 5-year study period (1994-99), the more recent guidelines were more likely to use multidisciplinary development panels, report the literature search strategies and grade the quality of the evidence. The CPG development process in Canada is becoming more rigorous and reproducible, but there is still considerable room for improvement. In addition to encouraging Canadian guideline developers to use more rigorous and transparent methods, considerably more attention must be focused on using and identifying effective and cost-effective strategies to promote and facilitate the uptake of guidelines by practitioners and to evaluate the impact of guidelines on patient outcomes.
加拿大医学协会（CMA）维护着一个由加拿大各组织制定或认可的临床实践指南（CPG）数据库。该研究的目的是描述这些指南是如何制定、传播和评估的。1996年6月至1999年12月期间，向CMA信息库中注册的每个CPG的制定者邮寄了一份调查问卷。收到了75个组织制定的730份独特指南的数据（回复率为70%）。其中，72%是由有正式成员选拔程序的委员会制定的。对所有指南都进行了科学文献综述，88%进行了计算机检索，检索策略涵盖了34%的CPG文件。对54%的指南所依据证据的质量进行了评级尝试。对于大多数指南，通过公开讨论由专家意见达成了关于价值观或判断的共识（78%的指南）。传播指南最常用的策略是将指南直接邮寄给制定组织的成员（占所有指南的80%）、在通讯/期刊上发表指南（76%）、直接邮寄给其他方（73%）、电子传播（62%）、教育或继续医学教育活动（50%）以及向患者/消费者提供指南信息（47%）。总体而言，5%的指南已被评估以确定其对健康结果的影响。在为期5年的研究期间（1994 - 99年），较新的指南更有可能使用多学科制定小组、报告文献检索策略并对证据质量进行评级。加拿大的CPG制定过程正变得更加严格且可重复，但仍有很大的改进空间。除了鼓励加拿大的指南制定者使用更严格和透明的方法外，还必须更加关注使用和确定有效且具有成本效益的策略，以促进和推动从业者采用指南，并评估指南对患者结果的影响。
