Baradaran-Seyed Zahra, Nedjat Sima, Yazdizadeh Bahareh, Nedjat Saharnaz, Majdzadeh Reza
School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Int J Prev Med. 2013 Mar;4(3):340-8.
Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran.
Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach.
Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context.
The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.
临床实践指南（CPG）等知识产品是循证医学（EBM）所急需的。尽管近年来在一定程度上对循证医学有所关注，但目前尚未取得成果。当前的定性研究旨在确定在伊朗建立临床实践指南制定和实施体系的障碍。
对卫生政策和决策者、临床实践指南制定和/或改编专家以及循证医学教育与发展专家进行了12次半结构化深入访谈。此外，11名卫生系统的政策制定者、决策者和管理人员参加了焦点小组讨论。采用主题框架法对研究数据进行分析。
按出现频率排序出现了六个主题，包括实践环境、循证医疗系统、个体专业人员、政治家和政治背景、创新（临床实践指南）以及患者。治疗环境中的大多数指标集中在法规和规则、经济因素、组织背景和社会背景等子主题上。虽然其他研究之前已经确定了与治疗环境条件、服务提供者以及创新和患者特征相关的障碍，但对循证医疗系统以及政治家和政治背景的关注却很少。
作为一个发展中国家，伊朗缺乏循证医疗系统和政治宏观支持被认为是关键障碍。除非消除这些障碍，否则不可能建立作为循证实践工具的临床实践指南制定和实施体系。
