Rosser Walter
Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, Ontario K7L5E9, Canada.
Fam Pract. 2008 Dec;25 Suppl 1:i38-43. doi: 10.1093/fampra/cmn080. Epub 2008 Nov 12.
The transfer of evidence from research into clinical practice is made almost impossible by enormous volume of literature on any topic. Consolidated evidence into guidelines is not very helpful as there are usually 50 guidelines existing on common clinical topics. Clinicians need assistance in identifying the best available evidence. This paper describes two strategies to transfer research evidence into clinical practice.
The Guideline Advisory Committee (GAC) in Ontario has assessed all available guidelines on 70 clinical topics using a validated and transparent process involving community-based physicians as assessors. A single best guideline is selected and a summary of its evidence-based recommendations are produced for easy use by practitioners (http://www.gacguidelines.ca). The Critically Appraised Practice Reflection Exercise (CAPRE) programme takes the best available evidence on 40 common practice problems, presents a summary for clinician and patient, has a strategy for physician and patient to find common ground in applying the evidence and has the practitioner to carry out a reflection exercise to gain continuing education credits (http://www.capre.ca). Distribution of these strategies in practice-based research networks is a further step in making research more relevant to practice.
The GAC website has more than 100,000 'hits' per month and 4500 identified regular users from Canada and the world. The numbers are steadily increasing. The CAPRE programme has not been formally evaluated but over 150 clinicians have used the programme with patients. With a national launch, the programme there between 60,000 and 80,000 hits per week with 100 physicians completing the programme for continuing medical education (CME) credits in the first month. Physicians report that their patients are very pleased with their physician using the latest evidence to address their problem. This is true even if the patient does not agree to follow the evidence-based recommendations. Using these programmes in practice-based research, networks should further promote making research more relevant to practice.
Transferring research-based evidence into clinical practice has many challenges. Two programmes developed to address these challenges are described. Although not fully evaluated, there is some evidence of success.
由于任何主题的文献数量庞大，将研究证据转化为临床实践几乎变得不可能。将证据整合到指南中帮助不大，因为常见临床主题通常有50种指南。临床医生在确定最佳可用证据方面需要帮助。本文描述了两种将研究证据转化为临床实践的策略。
安大略省的指南咨询委员会（GAC）使用经过验证且透明的流程，以社区医生为评估者，对70个临床主题的所有可用指南进行了评估。选择单一最佳指南，并生成其基于证据的建议摘要，供从业者轻松使用（http://www.gacguidelines.ca）。批判性评估实践反思练习（CAPRE）计划获取40个常见实践问题的最佳可用证据，为临床医生和患者提供摘要，有让医生和患者在应用证据方面找到共同点的策略，并让从业者进行反思练习以获得继续教育学分（http://www.capre.ca）。在基于实践的研究网络中推广这些策略是使研究与实践更相关的进一步举措。
GAC网站每月有超过100,000次“点击”，并从加拿大和世界各地识别出4500名定期用户。这些数字在稳步增加。CAPRE计划尚未经过正式评估，但已有超过150名临床医生与患者一起使用该计划。随着在全国范围内推出，该计划每周有60,000至80,000次点击，第一个月有100名医生完成该计划以获得继续医学教育（CME）学分。医生报告说，他们的患者对医生使用最新证据解决他们的问题非常满意。即使患者不同意遵循基于证据的建议，情况也是如此。在基于实践的研究中使用这些计划，网络应进一步促进使研究与实践更相关。
将基于研究的证据转化为临床实践有许多挑战。本文描述了为应对这些挑战而开发的两个计划。虽然尚未进行全面评估，但有一些成功的证据。
