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德黑兰只有三分之一的医生熟悉“循证临床指南”。

Only One Third of Tehran's Physicians are Familiar with 'Evidence-Based Clinical Guidelines'.

作者信息

Mounesan Leila, Nedjat Saharnaz, Majdzadeh Reza, Rashidian Arash, Gholami Jaleh

机构信息

Department of Epidemiology, School of Public Health and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Int J Prev Med. 2013 Mar;4(3):349-57.

Abstract

BACKGROUND

Clinical guidelines have increasingly been used as tools for applying new knowledge and research findings. Although, efforts have been made to produce clinical guidelines in Iran, it is not clear whether they have been used by physicians and what factors are associated with them?.

METHODS

Four hundred and forty three practicing physicians in Tehran were selected from private clinics through weighted random sampling. The data collection tool was a questionnaire on familiarity and attitude toward clinical guidelines. The descriptive and analytical findings were analyzed with t-tests, Chi(2), logistic and linear multivariate regression by SPSS, version 16.

RESULTS

31.8% of physicians were familiar with clinical guidelines. Based on the logistic regression model physicians' familiarity with clinical guidelines was positively and significantly associated with 'working experience in a health service delivery point' OR = 2.13 (95% CI, 1.17-3.90), 'familiarity with therapeutic protocols' OR = 2.09 (95% CI, 1.22-3.57) and 'holding a specialty degree' OR = 2.51 (95% CI, 1.24-5.07). The mean overall attitude scores in the 'usefulness', 'reliability', and 'problems and barriers' domains were, respectively, 78.9 (SD = 16.5), 78.9 (SD = 19.7) and 50.4 (SD = 15.9) out of a total of 100 scores in each domain. No significant association was observed between attitude domains and other independent variables using multivariate linear regression.

CONCLUSIONS

Little familiarity with clinical guidelines may represent weakness in of production and distribution of domestic evidence. Although, physicians considered guidelines as useful and reliable tools, but problems such as difficult access to guidelines and lack of facilities to apply them were stated as well.

摘要

背景

临床指南越来越多地被用作应用新知识和研究成果的工具。尽管伊朗已努力制定临床指南,但尚不清楚医生是否使用了这些指南以及与之相关的因素有哪些?

方法

通过加权随机抽样从德黑兰的私人诊所中选取了443名执业医生。数据收集工具是一份关于对临床指南的熟悉程度和态度的问卷。使用SPSS 16版通过t检验、卡方检验、逻辑回归和线性多元回归对描述性和分析性结果进行分析。

结果

31.8%的医生熟悉临床指南。根据逻辑回归模型,医生对临床指南的熟悉程度与“在医疗服务提供点的工作经验”呈正相关且具有统计学意义,比值比(OR)=2.13(95%置信区间,1.17 - 3.90);与“熟悉治疗方案”呈正相关且具有统计学意义,OR = 2.09(95%置信区间,1.22 - 3.57);与“拥有专业学位”呈正相关且具有统计学意义,OR = 2.51(95%置信区间,1.24 - 5.07)。在“有用性”“可靠性”和“问题与障碍”领域的平均总体态度得分分别为78.9(标准差 = 16.5)、78.9(标准差 = 19.7)和50.4(标准差 = 15.9),每个领域满分均为100分。使用多元线性回归未观察到态度领域与其他自变量之间存在显著关联。

结论

对临床指南的了解程度较低可能表明国内证据的产生和传播存在不足。尽管医生们认为指南是有用且可靠的工具,但也指出了诸如难以获取指南以及缺乏应用指南的设施等问题。

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