Hartmann M, Gundermann C, Richter A, Eidner T, Hein G
Universitätsklinikum Jena, Erlanger Allee 101, 07747 Jena.
Dtsch Med Wochenschr. 2008 Aug;133(34-35):1721-4. doi: 10.1055/s-0028-1082793.
There are indications that the influence of external guidelines on the quality of health care is limited and they are little or not at all used in clinical practice. It was the aim of this study to examine how and to what extent the external S3 guideline "Management of Early Rheumatoid Arthritis" was applied in a rheumatism center.
In accordance with the data of all rheumatoid arthritis patients, who were treated November 2007, an investigation was carried out on the degree of application and realization of the S3 guideline which had been changed into an internal guideline. The primary objective was the Disease Modifying Anti-Rheumatic Drug (DMARD) therapy; secondary objectives were the administration of methotrexate with folic acid, the administration of glucocorticoids with calcium and vitamin D; and NSAR monotherapy.
94.6 % of the patients were given a therapy of basis drugs (DMARDs). 82.5 % of the methotrexate patients additionally received folic acid. 65.9 % of the patients received, in addition to glucocorticoids, calcium and vitamin D. In 99.1 % of the cases NSAR monotherapy was instituted.
The high degree of application does not correspond with the results of previous studies on guideline compliance with external guidelines. A possible explanation of this may be the change made of the external guideline to a guideline within the hospital.
有迹象表明，外部指南对医疗质量的影响有限，在临床实践中很少或根本未被采用。本研究的目的是调查外部S3指南“早期类风湿性关节炎的管理”在一家风湿病中心是如何应用的以及应用程度如何。
根据2007年11月接受治疗的所有类风湿性关节炎患者的数据，对已转变为内部指南的S3指南的应用和实施程度进行了调查。主要目标是疾病改善抗风湿药物（DMARD）治疗；次要目标是甲氨蝶呤与叶酸联合给药、糖皮质激素与钙和维生素D联合给药；以及非甾体类抗炎药（NSAR）单药治疗。
94.6%的患者接受了基础药物（DMARDs）治疗。82.5%的甲氨蝶呤患者额外接受了叶酸。65.9%的患者除接受糖皮质激素外，还接受了钙和维生素D。在99.1%的病例中采用了NSAR单药治疗。
高应用程度与先前关于外部指南遵循情况的研究结果不一致。对此的一个可能解释是外部指南转变为了医院内部的指南。
