Department of Public Health/Health Policy, The University of Tokyo, Japan.
Int J Qual Health Care. 2010 Apr;22(2):78-85. doi: 10.1093/intqhc/mzp060. Epub 2010 Jan 15.
To examine the views of rheumatology physicians concerning clinical practice guidelines in Japan, and changes to them following the dissemination of new guidelines for rheumatoid arthritis (RA) in 2004.
Two cross-sectional questionnaire surveys, the first conducted before publication of new evidence-based RA clinical practice guidelines and the second conducted after implementation.
Rheumatology-focused practices in Japan.
A random sample of physicians registered with the Japan Rheumatism Foundation who satisfied the registration criteria with regard to experience with RA care.
The percentage of guideline users increased from 48 to 60% following publication of the new RA guidelines in 2004 (P < 0.01). The majority agreed that clinical practice guidelines support decision-making in practice, although the proportion of supportive responses decreased slightly in the second survey, from 83 to 77% (P < 0.01) for decision-making, while concern about restricting physician autonomy increased from 18 to 22% (P = 0.01). While only 39% of physicians felt that clinical practice guidelines would contribute to malpractice litigation, the proportion of physicians who were concerned that clinical practice guidelines would be used to bring legal action against providers was larger than that who expected they would defend providers (58 vs 30%, P < 0.001).
Clinical practice guidelines are well accepted among Japanese rheumatology physicians, albeit that the proportion decreased slightly after the introduction of new guidelines. One reason for this may be concern about the use of the guidelines in malpractice litigation. To facilitate implementation, trends in physician support for the guidelines should be closely monitored.
考察日本风湿病医生对临床实践指南的看法，以及 2004 年发布新的类风湿关节炎（RA）临床实践指南后指南的变化。
在发布新的基于证据的 RA 临床实践指南之前进行了第一次横断面问卷调查，在实施后进行了第二次横断面问卷调查。
日本以风湿病为重点的诊所。
日本风湿病基金会注册的符合 RA 护理经验注册标准的随机抽取的医生。
2004 年新的 RA 指南发布后，指南使用者的比例从 48%增加到 60%（P < 0.01）。大多数人认为临床实践指南支持实践中的决策，但在第二次调查中，支持性反应的比例略有下降，从 83%降至 77%（P < 0.01），而对限制医生自主权的担忧从 18%增加到 22%（P = 0.01）。尽管只有 39%的医生认为临床实践指南会导致医疗事故诉讼，但担心临床实践指南会被用来对提供者提起法律诉讼的医生比例大于预计会为提供者辩护的医生比例（58%对 30%，P < 0.001）。
临床实践指南在日本风湿病医生中得到了很好的认可，尽管在引入新指南后，其比例略有下降。出现这种情况的一个原因可能是担心在医疗事故诉讼中使用这些指南。为了促进实施，应密切监测医生对指南的支持趋势。
