Waldorff Frans Boch, Almind Gert, Mäkelä Marjukka, Møller Susanne, Waldemar Gunhild
Central Research Unit, Department of General Practice, Institute of Public Health, University of Copenhagen, Denmark.
Scand J Prim Health Care. 2003 Sep;21(3):142-7. doi: 10.1080/02813430310005136.
To assess the impact of a multifaceted implementation strategy aiming to improve GP adherence to a clinical guideline on dementia.
Controlled before and after study using data records from regional laboratories. The guideline was mailed to all GPs. The multifaceted implementation strategy was planned with local GPs, and consisted of seminars, outreach visits, reminders and continuing medical education (CME) small group training.
Primary health care.
535 GP practices with 727 physicians in Denmark.
The diffusion and use of the guideline was measured by a mailed survey. Adherence to guideline recommendations was monitored by data on laboratory tests from general practice in patient's > or = 65 years: thyroid stimulating hormone requested with vitamin B12 or methylmalonate. The use of these tests as part of a diagnostic evaluation of dementia was subsequently verified by a questionnaire to the practices.
Of the GPs who read the guideline, 88% found it applicable in primary care. No increase in the adherence to guideline recommendations was observed regarding the use of laboratory tests or cognitive tests in the diagnostic evaluation of dementia in general practice.
Although GPs regarded the guideline applicable in primary care, no change in practice adherence to guideline recommendations was detected after a multifaceted implementation.
评估旨在提高全科医生（GP）对痴呆症临床指南依从性的多方面实施策略的影响。
采用区域实验室的数据记录进行前后对照研究。该指南已邮寄给所有全科医生。多方面实施策略是与当地全科医生共同制定的，包括研讨会、外展访问、提醒以及继续医学教育（CME）小组培训。
初级卫生保健。
丹麦535家全科医生诊所的727名医生。
通过邮寄调查来衡量指南的传播和使用情况。通过65岁及以上患者全科医疗中实验室检查的数据来监测对指南建议的依从性：在检测维生素B12或甲基丙二酸时同时检测促甲状腺激素。随后通过向诊所发放问卷来核实这些检查作为痴呆症诊断评估一部分的使用情况。
阅读该指南的全科医生中，88%认为其适用于初级保健。在全科医疗中对痴呆症进行诊断评估时，就实验室检查或认知测试的使用而言，未观察到对指南建议的依从性有所增加。
尽管全科医生认为该指南适用于初级保健，但在多方面实施后，未检测到实践中对指南建议的依从性有变化。
