Proc Am Thorac Soc. 2012 Dec;9(5):219-24. doi: 10.1513/pats.201208-054ST.
Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are informed by the best available research evidence. Different clinical practice guidelines addressing the management of the same disease may vary widely in the evidence used and the format of the recommendations, with the result that not all are appropriate for all audiences. This is the first of a series of 14 articles that clinicians, methodologists, and researchers from around the world prepared to advise those developing guidelines in respiratory and other diseases about the potential impact of identifying the target audiences for their clinical practice guidelines.
In this review we address the following questions. (1) Which audiences are interested in a chronic obstructive pulmonary disease (COPD) guideline? (2) How many audiences can be addressed in a single COPD guideline? (3) What is the purpose of the guidelines? (4) Who should be included on the guideline panel? We collected information by searching PubMed and reviewing information from groups that are currently making and using respiratory disease guidelines, as well as from workshop discussions. Our conclusions are based on available evidence, consideration of what guideline developers are doing, and the opinions of those who attended the workshop.
Clinicians desire COPD and other guidelines that are concise, use evidence from practices similar to theirs, and whose authors have expertise in providing care in similar settings and with similar patients. In the case of COPD, barriers to generalists' use of guidelines include lack of awareness of the guidelines, failure to embrace the diagnostic methods as capable of providing definitive confirmation of COPD, and, most importantly, failure of previous guidelines to address the treatment of COPD in the context of the broad range of multiple morbidities that affect most people with COPD. COPD specialists may require guidelines with more details regarding complex COPD management. The purpose of the guidelines may determine the appropriate audience. Guidelines developed to improve care by enhancing education may have a very different audience than guidelines designed to improve care by limiting the scope of practice, punishing noncompliance, or saving money. The purpose will drive dissemination and implementation strategies, but should not influence the methods used to develop a guideline. Clinicians desire guidelines, but data suggest that the current development systems, content, format, and dissemination strategies may need to be altered to fit these audiences. After the purpose and audience are determined, the guideline committee must decide how to fairly address these audiences, which will usually require seeking their input.
专业学会与全球其他许多组织一样，已经认识到需要采用严格的流程来确保医疗保健建议基于最佳现有研究证据。针对同一疾病的不同临床实践指南在使用的证据和建议格式方面可能存在很大差异，结果是并非所有指南都适合所有受众。这是来自全球的临床医生、方法学家和研究人员为那些制定呼吸和其他疾病临床实践指南的人员准备的 14 篇系列文章中的第一篇，旨在就确定其临床实践指南的目标受众对指南产生的潜在影响提供建议。
在这篇综述中，我们将回答以下问题。（1）哪些受众对慢性阻塞性肺疾病（COPD）指南感兴趣？（2）一个 COPD 指南可以针对多少个受众？（3）指南的目的是什么？（4）指南小组应该由谁组成？我们通过搜索 PubMed 和审查目前正在制定和使用呼吸疾病指南的小组的信息以及研讨会讨论来收集信息。我们的结论基于现有证据、考虑指南制定者的做法以及参加研讨会人员的意见。
临床医生希望 COPD 和其他指南简明扼要，使用与他们相似的实践中的证据，并且其作者在类似环境中为类似患者提供护理方面具有专业知识。在 COPD 的情况下，限制全科医生使用指南的因素包括对指南缺乏认识、不接受诊断方法能够明确确定 COPD，以及最重要的是，以前的指南未能在影响大多数 COPD 患者的多种合并症的背景下解决 COPD 的治疗问题。COPD 专家可能需要更详细的指南来处理复杂的 COPD 管理问题。指南的目的可能会决定适当的受众。旨在通过提高教育来改善护理的指南可能与旨在通过限制实践范围、惩罚不遵守规定或节省资金来改善护理的指南具有非常不同的受众。目的将推动传播和实施策略，但不应影响制定指南所使用的方法。临床医生希望获得指南，但数据表明，当前的发展系统、内容、格式和传播策略可能需要改变以适应这些受众。在确定目的和受众之后，指南委员会必须决定如何公平地针对这些受众，这通常需要征求他们的意见。
