Kürstein Pia, Gluud Lise L, Willemann Marlene, Olsen Kim R, Kjellberg Jakob, Sogaard Jes, Gluud Christian
DSI Danish Institute for Health Services Research, Copenhagen, Denmark.
J Hepatol. 2005 Dec;43(6):984-9. doi: 10.1016/j.jhep.2005.06.017. Epub 2005 Jul 12.
BACKGROUND/AIMS: This study evaluates the agreement between reported use of interventions for patients with liver diseases and research evidence in Cochrane systematic reviews.
In July 2002, the Cochrane Hepato-Biliary Group had completed 28 systematic reviews on 36 interventions that were available in Denmark. Based on the reviews, three interventions (n-acetylcysteine for paracetamol overdose, terlipressin for bleeding oesophageal varices, and antibiotics for patients with cirrhosis and gastrointestinal bleeding) with significant beneficial effects on clinical outcomes were classified as 'evidence-based', whereas 19 were classified as 'possibly evidence-based', and 14 as 'not evidence-based'. Questionnaires on reported use and perceived intervention effects were mailed to 108 physicians practising in Danish hospitals. Sixty-six returned their questionnaire.
The proportion of physicians who reported that they never used the three evidence-based interventions varied considerably (2, 62, and 57%, respectively). The perceived intervention effect, duration of clinical experience, employment as head of department, and university hospital employment were significant predictors of more frequent use of evidence-based interventions. Physicians also reported that they used the interventions that were not evidence-based more often if they were employed at a university hospital.
Considerable disagreements between reported use and research evidence were identified. Additional research on methods to introduce evidence-based medicine in practice seems warranted.
背景/目的：本研究评估了针对肝病患者所报告的干预措施使用情况与Cochrane系统评价中的研究证据之间的一致性。
2002年7月，Cochrane肝胆组已完成了对丹麦现有的36种干预措施的28项系统评价。基于这些评价，对临床结局有显著有益影响的三种干预措施（对乙酰氨基酚过量使用n - 乙酰半胱氨酸、食管静脉曲张出血使用特利加压素、肝硬化和胃肠道出血患者使用抗生素）被归类为“基于证据的”，而19种被归类为“可能基于证据的”，14种被归类为“非基于证据的”。关于所报告的使用情况和感知到的干预效果的问卷被邮寄给在丹麦医院执业的108名医生。66人返回了问卷。
报告从未使用这三种基于证据的干预措施的医生比例差异很大（分别为2%、62%和57%）。感知到的干预效果、临床经验时长、担任科室主任以及在大学医院工作是更频繁使用基于证据的干预措施的显著预测因素。医生们还报告说，如果他们在大学医院工作，他们更经常使用非基于证据的干预措施。
在所报告的使用情况与研究证据之间发现了相当大的不一致。似乎有必要对在实践中引入循证医学的方法进行更多研究。
