Butzlaff Martin, Kempkens Daniela, Schnee Melanie, Dieterle Wilfried E, Böcken Jan, Rieger Monika A
Competence Center for General Medicine and Outpatients' Health Care, Faculty of Medicine, University Witten/Herdecke, Alfred-Herrhausen-Str, 50, D 58448 Witten, Germany.
BMC Fam Pract. 2006 Jul 20;7:47. doi: 10.1186/1471-2296-7-47.
There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice.
Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables.
Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care.
Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.
关于德国医生在多大程度上接受或拒绝以下概念及实践，即a) 临床实践指南（CPG）和b) 循证医学（EBM），目前几乎没有系统的研究。本研究的目的是调查德国门诊医生对CPG和EBM的看法及其在医疗实践中的应用情况。
对门诊护理医生进行全国性结构化电话调查，有四个主题板块共21个问题（采用5级李克特量表）。调查对象为511名门诊全科医生和专科医生。主要观察指标为临床实践指南在日常实践中的应用情况、对指南来源的偏好以及对循证医学的了解程度和接受程度。数据分析采用Pearson相关系数进行相关性探索性分析。组间比较采用Student's t检验。卡方检验用于调查两个或多个分类变量的分布情况。
在全部研究对象中，55.3%的医生报告已在患者治疗中使用指南。与个体执业医生（SP）或专科医生（S）相比，团队执业医生（GrP）以及全科医生（GP）显著更认同指南作为患者护理依据的有用性（Student's t检验：GP均值2.57，S均值2.84，p < 0.01；GrP均值2.55，SP均值2.80，p < 0.05）。33.1%的参与者强烈反对在患者护理中应用指南。对政府机构制定的指南的接受度显著低于医生网络或医学协会制定的指南（分别为36.2%、53.4%和62.0%）。73.8%的医生将循证医学解释为科学研究与个人医学知识的结合；80%的医生认为循证医学是患者护理的最佳依据。
尽管大多数医生接受并应用CPG，但仍有一大部分医生对在日常实践中使用CPG以及总体上对循证医学概念持批评和反对态度。个体执业医生和专科医生似乎比团队执业医生和全科医生更为挑剔。未来需要开展研究以评估医生获取推广和常规应用CPG所需知识和技能的意愿。
