Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Crit Care Med. 2010 Aug;38(8 Suppl):S282-91. doi: 10.1097/CCM.0b013e3181e69e02.
Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions.
A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models.
Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance.
An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.
我们的目的是采用跨学科的方法确定影响临床医生遵循循证指南的因素，并制定一个概念框架，为设计有效的干预措施提供全面实用的指南。
通过对来自不同科学领域的 11 位研究人员进行文献回顾和头脑风暴，确定了描述临床医生遵循指南的理论和概念模型。我们使用 MEDLINE、EMBASE、CINAHL 和确定的论文参考文献作为确定相关理论和概念模型的数据源。
从医学、农村社会学、心理学、人为因素和系统工程、组织管理、市场营销和健康教育等不同学科中确定了 13 个不同的模型。我们的分析得出了影响遵从性的四个主要因素类别：临床医生特征、指南特征、系统特征和实施特征。基于这些发现，我们开发了一个跨学科的概念框架，具体说明了这四个因素类别之间的预期相互关系及其对临床医生遵从性的影响。
需要采用跨学科的方法来提高临床医生对循证指南的遵从性。本研究的概念框架可以为确定指南遵从性的障碍以及设计改善患者安全的有效干预措施提供全面系统的指导。
