实施临床实践指南的障碍和促进因素：爱沙尼亚医生的横断面调查。
Barriers and facilitators to the implementation of clinical practice guidelines: a cross-sectional survey among physicians in Estonia.
机构信息
Department of Continuing Medical Education, University of Tartu, Puusepa 8, Tartu, 51014, Estonia.
出版信息
BMC Health Serv Res. 2012 Dec 13;12:455. doi: 10.1186/1472-6963-12-455.
BACKGROUND
In an era when an increasing amount of clinical information is available to health care professionals, the effective implementation of clinical practice guidelines requires the development of strategies to facilitate the use of these guidelines. The objective of this study was to assess attitudes towards clinical practice guidelines, as well as the barriers and facilitators to their use, among Estonian physicians. The study was conducted to inform the revision of the clinical practice guideline development process and can provide inspiration to other countries considering the increasing use of evidence-based medicine.
METHODS
We conducted an online survey of physicians to assess resource, system, and attitudinal barriers. We also asked a set of questions related to improving the use of clinical practice guidelines and collected free-text comments. We hypothesized that attitudes concerning guidelines may differ by gender, years of experience and practice setting. The study population consisted of physicians from the database of the Department of Continuing Medical Education of the University of Tartu. Differences between groups were analyzed using the Kruskal-Wallis non-parametric test.
RESULTS
41% (497/1212) of physicians in the database completed the questionnaire, comprising more than 10% of physicians in the country. Most respondents (79%) used treatment guidelines in their daily clinical practice. Lack of time was the barrier identified by the most physicians (42%), followed by lack of medical resources for implementation (32%). The majority of physicians disagreed with the statement that guidelines were not accessible (73%) or too complicated (70%). Physicians practicing in outpatient settings or for more than 25 years were the most likely to experience difficulties in guideline use. 95% of respondents agreed that an easy-to-find online database of guidelines would facilitate use.
CONCLUSIONS
Use of updated evidence-based guidelines is a prerequisite for the high-quality management of diseases, and recognizing the factors that affect guideline compliance makes it possible to work towards improving guideline adherence in clinical practice. In our study, physicians with long-term clinical experience and doctors in outpatient settings perceived more barriers, which should be taken into account when planning strategies in improving the use of guidelines. Informed by the results of the survey, leading health authorities are making an effort to develop specially designed interventions to implement clinical practice guidelines, including an easily accessible online database.
背景
在当今时代，越来越多的临床信息可供医疗保健专业人员使用，为了有效实施临床实践指南，需要制定促进使用这些指南的策略。本研究的目的是评估爱沙尼亚医生对临床实践指南的态度，以及使用这些指南的障碍和促进因素。该研究旨在为修订临床实践指南制定过程提供信息，并为其他考虑增加循证医学使用的国家提供启示。
方法
我们对医生进行了在线调查，以评估资源、系统和态度障碍。我们还提出了一组与改善临床实践指南使用相关的问题，并收集了自由文本意见。我们假设，对指南的态度可能因性别、经验年限和实践环境而异。研究人群由塔尔图大学继续教育医学系数据库中的医生组成。使用 Kruskal-Wallis 非参数检验分析组间差异。
结果
数据库中有 41%（497/1212）的医生完成了问卷，占该国医生的 10%以上。大多数受访者（79%）在日常临床实践中使用治疗指南。最多的医生（42%）认为缺乏时间是障碍，其次是缺乏实施的医疗资源（32%）。大多数医生不同意指南无法获取（73%）或过于复杂（70%）的说法。在门诊或工作超过 25 年的医生最有可能在使用指南方面遇到困难。95%的受访者同意易于查找的在线指南数据库将有助于使用。
结论
使用更新的基于证据的指南是高质量管理疾病的前提，认识到影响指南遵守的因素使我们有可能努力改善临床实践中的指南遵守情况。在我们的研究中，具有长期临床经验的医生和门诊医生认为存在更多障碍，在制定改善指南使用的策略时应考虑这些障碍。在调查结果的基础上，主要卫生当局正在努力制定专门的干预措施来实施临床实践指南，包括一个易于访问的在线数据库。
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