School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd, Room 3051, Ottawa, Ontario, K1H 8M5, Canada.
Implement Sci. 2009 Aug 5;4:49. doi: 10.1186/1748-5908-4-49.
Despite the growing availability of clinical practice guidelines since the early 1990's, little is known about how guideline development and dissemination may have changed over time in Canada. This study compares Canadian guideline development, dissemination, and evaluation in two six year periods from 1994-1999 and 2000-2005.
Survey of guideline developers who submitted their clinical practice guidelines to the Canadian Medical Association Infobase (a Canadian guideline repository) between 1994 and 2005. Survey items included information about the developers, aspects of guideline development, and dissemination and evaluation activities.
Surveys were sent to the developers of 2341 guidelines in the CMA Infobase over the 12 year period, 1664 surveys were returned (response rate 71%). Of these, 730 unique guidelines were released from 1994-1999, and 630 were released from 2000-2005. Compared to the earlier period, more recent guidelines were being produced in English only. There has been little change in the type of organizations developing guidelines with most developed by provincial and national organizations. In the recent period, developers were more likely to report using computerized search strategies (94% versus 88%), publishing the search strategy (42% versus 34%), reaching consensus using open discussion (95% versus 78%), and evaluating effectiveness of the dissemination strategies (12% versus 6%) and the impact of the CPGs on health outcomes (24% versus 5%). Recent guidelines were less likely to be based on literature reviews (94% versus 99.6%) and were disseminated using fewer strategies (mean 4.78 versus 4.12).
Given that guideline development processes have improved in some areas over the past 12 years yet not in others, ongoing monitoring of guideline quality is required. Guidelines produced more recently in Canada are less likely to be based on a review of the evidence and only about half discuss levels of evidence underlying recommendations. Guideline dissemination and implementation activities have actually decreased. Unfortunately, the potential positive impact on patient health outcomes will not be realized until the recommendations are adopted and acted upon.
尽管自 20 世纪 90 年代初以来，临床实践指南的可获得性不断增加，但对于指南的制定和传播在加拿大是否随时间而改变知之甚少。本研究比较了加拿大在 1994-1999 年和 2000-2005 年两个六年期间的指南制定、传播和评估情况。
对在 1994 年至 2005 年期间向加拿大医师协会信息库（加拿大指南库）提交临床实践指南的指南制定者进行调查。调查项目包括制定者的信息、指南制定的各个方面以及传播和评估活动。
在 12 年期间，向加拿大医师协会信息库中的 2341 项指南的制定者发送了调查，但仅收到 1664 份回复（回复率为 71%）。其中，1994-1999 年发布了 730 项独特的指南，2000-2005 年发布了 630 项。与早期相比，最近的指南仅用英语发布。制定指南的组织类型几乎没有变化，大部分是由省级和国家级组织制定的。在最近的时期，制定者更有可能报告使用计算机化搜索策略（94%对 88%）、公布搜索策略（42%对 34%）、使用公开讨论达成共识（95%对 78%）、评估传播策略的效果（12%对 6%）以及评估 CPG 对健康结果的影响（24%对 5%）。最近的指南不太可能基于文献综述（94%对 99.6%），传播策略也较少（平均 4.78 项对 4.12 项）。
鉴于过去 12 年来，指南制定过程在某些方面有所改进，但在其他方面并未改进，因此需要对指南质量进行持续监测。加拿大最近发布的指南不太可能基于证据综述，只有约一半的指南讨论了推荐建议所依据的证据水平。指南的传播和实施活动实际上减少了。不幸的是，除非建议被采纳并付诸实施，否则不会对患者的健康结果产生积极影响。
