University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada.
Implement Sci. 2012 Jul 23;7:67. doi: 10.1186/1748-5908-7-67.
Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice.
We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements.
Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients.
Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.
指南是根据最佳现有研究证据为医疗保健提供信息的重要工具。指南的使用部分基于指南的质量，其中包括实施建议，并且已经表明其存在差异。其他人假设这是由于指南制定手册中有限的实施建议说明。本研究旨在检查实施建议的手册说明。
我们使用了一种基于指南可实施性既定框架的定向和总结性内容分析方法。检查了另一个研究小组确定的六本手册，以列举可实施性领域和要素。
手册内容相似，但在特定领域缺乏足够的细节。最常见的是适应性，其中包括有助于指南使用者预测和/或克服组织和系统层面障碍的信息。在不止一本手册中，也缺乏可传达性的信息，即教育患者或促进他们参与共同决策的信息，以及适用性，即帮助临床医生为个别患者定制建议的临床参数。
大多数指导指南制定的手册缺乏有关纳入实施建议的完整信息。这些发现可被手册制定者用于考虑在这些领域扩展其内容。它还可以为指南制定者在计划指南的内容和实施时提供参考，以便将两者整合。可能需要开发新的指南制定和实施方法。如果指南包括实施建议，可能会提高其使用效果，但这必须通过持续研究进行评估。
