Baker Richard, Fraser Robin C, Stone Margaret, Lambert Paul, Stevenson Keith, Shiels Chris
Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW.
Br J Gen Pract. 2003 Apr;53(489):284-91.
Guidelines are frequently used in an attempt to influence the performance of health professionals, and a national agency has been established in England and Wales to develop and disseminate guidelines. Professionals prefer short guidelines that highlight key recommendations, but whether such guidelines are more likely to be implemented is unknown.
To determine the relative impact of the dissemination of full guidelines, reduced guidelines in the form of prioritized review criteria, and review criteria supplemented by feedback.
Cluster randomised controlled trial, with an incomplete block design.
Eighty-one general practices in Leicestershire, Lincolnshire, Northamptonshire, North Derbyshire, and Nottinghamshire.
The practices received one of the study interventions, either for care of adults with asthma or for care of people with angina. Data were collected before and after the interventions, the process measures being adherence to ten recommendations about asthma and 14 about angina, and outcome measures being scores in response to an asthma symptom questionnaire or the Seattle Angina Questionnaire, and levels of patient satisfaction.
There were no consistent differences between the interventions in stimulating improvements in performance as indicated by adherence to the recommendations for asthma or angina. Patients with angina in practices that had received criteria or criteria plus feedback reported better symptom control.
The dissemination of guidelines in the format of prioritized review criteria does not increase adherence to recommendations in comparison with the traditional guideline format, and the further provision of feedback has minimal additional effect.
指南常被用于试图影响卫生专业人员的行为，英格兰和威尔士已设立一个国家机构来制定和传播指南。专业人员更喜欢突出关键建议的简短指南，但此类指南是否更有可能得到实施尚不清楚。
确定完整指南的传播、以优先审查标准形式呈现的简化指南以及补充反馈的审查标准的相对影响。
整群随机对照试验，采用不完全区组设计。
莱斯特郡、林肯郡、北安普敦郡、北德比郡和诺丁汉郡的81家全科诊所。
这些诊所接受了其中一项研究干预措施，要么是针对哮喘成年患者的护理，要么是针对心绞痛患者的护理。在干预前后收集数据，过程指标是对关于哮喘的10项建议和关于心绞痛的14项建议的遵循情况，结果指标是哮喘症状问卷或西雅图心绞痛问卷的得分以及患者满意度水平。
在促进遵循哮喘或心绞痛建议所表明的行为改善方面，各干预措施之间没有一致的差异。接受标准或标准加反馈的诊所中，心绞痛患者报告症状控制更好。
与传统指南形式相比，以优先审查标准形式传播指南并不会增加对建议的遵循，进一步提供反馈的额外效果微乎其微。
