Pitimana-Aree Siriporn, Uerpairojkit Ketchada, Punjasawadwong Yodying, Virankabutra Tanit, Charuluxananan Somrat
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Med Assoc Thai. 2007 Sep;90(9):1853-9.
Up to the present (2006), The Royal College of Anesthesiologists of Thailand (RCAT) has proposed and revised six practice guidelines. For guidelines to achieve their objectives, anyone who gets involved needs to be aware of the guidelines, be able to accept, and adhere to them. Although the authors did introduce their guidelines by several passive means, the authors have not yet ascertained what the result were.
The primary objective of the present study was to assess awareness, opinion, limitation, and reported use of guidelines. The secondary objective was to identify factors associated with variation, agreement, and reported use of guidelines.
A cross sectional, self-report survey study was conducted. An anonymous questionnaire including prepaid-addressed reply envelopes was mailed to 600 anesthesiologists and 1,300 nurse anesthetists, nationwide, based on the college's list. The questions covered respondents' general characteristics: awareness, agreement, and reported use of the existing guidelines; opinion on implementation media, which guidelines the members need, their local guidelines, and the impact of guidelines on their practice. All data were extracted and reported using descriptive statistics. Multiple logistic regression was done to identify factors associated with an agreement with and a reported use of the guidelines.
The overall response rate was 33.4% and nurse anesthetists had a higher response than anesthesiologists. Forty-six percent of the respondents were aware of the existing guidelines. This result corresponded to percentage of those who had read the guidelines (41%). Among the six existing guidelines, the least two guidelines reported use of and agreement with, were those for labor analgesia and conscious sedation (23-28%, 24-28%). The guidelines for spinal anesthesia received the most response (46%). For respondents who had read the guidelines, most of them (80% to 94%) rated the level of agreement and reported use as good to excellent. The respondents also rated the announcement of the guidelines during the annual meeting of the Royal College of Anesthesiologists of Thailand as the best implementation strategy. Impracticability, inadequate dissemination, and un-cooperation among colleagues were the three most important obstacles of using the guidelines. In addition, the present study demonstrated three significant factors, anesthesiologists, regional hospitals, and general hospitals, as associated with reporting frequent use of and high agreement with the guidelines.
The low level of awareness and reported use of the present guidelines among the members reflects poor implementation and dissemination. However the present study reveals some information that will guide the authors to introduce intensive and targeted interventions to encourage the members to comply and adhere to the guidelines designed to improve the quality of patients' care.
截至目前（2006年），泰国皇家麻醉师学院（RCAT）已提出并修订了六项实践指南。为使指南实现其目标，任何参与其中的人都需要了解这些指南，能够接受并遵守它们。尽管作者确实通过多种被动方式介绍了他们的指南，但尚未确定结果如何。
本研究的主要目的是评估对指南的知晓度、意见、局限性以及报告的使用情况。次要目的是确定与指南的差异、一致性以及报告的使用情况相关的因素。
进行了一项横断面的自我报告调查研究。根据学院名单，向全国600名麻醉师和1300名麻醉护士邮寄了一份包含预付回信信封的匿名问卷。问题涵盖受访者的一般特征：对现有指南的知晓度、一致性以及报告的使用情况；对实施媒介的意见、成员需要哪些指南、当地指南以及指南对其实践的影响。所有数据均采用描述性统计进行提取和报告。进行多因素逻辑回归以确定与对指南的一致性和报告的使用情况相关的因素。
总体回复率为33.4%，麻醉护士的回复率高于麻醉师。46%的受访者知晓现有指南。这一结果与阅读过指南的人的百分比（41%）相符。在六项现有指南中，报告使用和一致性最低的两项指南是分娩镇痛和清醒镇静指南（23 - 28%，24 - 28%）。脊髓麻醉指南的回复最多（46%）。对于阅读过指南的受访者，大多数人（80%至94%）将一致性水平和报告的使用情况评为良好至优秀。受访者还将在泰国皇家麻醉师学院年会上公布指南评为最佳实施策略。不切实际、传播不足以及同事之间不合作是使用指南的三个最重要障碍。此外，本研究表明麻醉师、地区医院和综合医院这三个因素与频繁使用指南和高度一致性报告相关。
成员对当前指南的知晓度和报告的使用水平较低，反映出实施和传播效果不佳。然而，本研究揭示了一些信息，将指导作者引入强化和有针对性的干预措施，以鼓励成员遵守和遵循旨在提高患者护理质量的指南。
