专业精神保健中的证据-实践差距：指南实施研究的系统评价和荟萃分析。
The evidence-practice gap in specialist mental healthcare: systematic review and meta-analysis of guideline implementation studies.
机构信息
Francesca Girlanda, PhD, Department of Psychiatry ll, Ulm University, Ulm, Germany, and Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Ines Fiedler, MSc, Thomas Becker, MD, Department of Psychiatry ll, Ulm University, Ulm, Germany; Corrado Barbui, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Markus Koesters, PhD, Department of Psychiatry ll, Ulm University, Ulm, Germany
Francesca Girlanda, PhD, Department of Psychiatry ll, Ulm University, Ulm, Germany, and Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Ines Fiedler, MSc, Thomas Becker, MD, Department of Psychiatry ll, Ulm University, Ulm, Germany; Corrado Barbui, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Markus Koesters, PhD, Department of Psychiatry ll, Ulm University, Ulm, Germany.
出版信息
Br J Psychiatry. 2017 Jan;210(1):24-30. doi: 10.1192/bjp.bp.115.179093. Epub 2016 Jul 21.
BACKGROUND
Clinical practice guidelines are not easily implemented, leading to a gap between research synthesis and their use in routine care.
AIMS
To summarise the evidence relating to the impact of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore the performance of different strategies for guideline implementation.
METHOD
A systematic review of randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care, and different guideline implementation strategies, in patients with severe mental illness.
RESULTS
In total, 19 studies met our inclusion criteria. The studies did not show a consistent positive effect of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes.
CONCLUSIONS
Guideline implementation does not seem to have an impact on provider performance, nonetheless it may influence patient outcomes positively.
背景
临床实践指南不易实施，导致研究综合与常规护理中应用之间存在差距。
目的
总结指南实施对精神卫生保健环境中提供者绩效和患者结局的影响的证据，并探讨不同指南实施策略的效果。
方法
对随机对照试验、对照临床试验和前后对照研究进行系统评价，比较严重精神疾病患者中指南实施策略与常规护理、不同指南实施策略之间的差异。
结果
共有 19 项研究符合纳入标准。这些研究并未显示指南实施对提供者绩效有一致的积极影响，但对患者结局有更一致的小到适度的积极影响。
结论
指南实施似乎对提供者绩效没有影响，但可能对患者结局产生积极影响。
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