Egerton T, Diamond L E, Buchbinder R, Bennell K L, Slade S C
Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Cabrini Health, Melbourne, Australia.
Osteoarthritis Cartilage. 2017 May;25(5):625-638. doi: 10.1016/j.joca.2016.12.002. Epub 2016 Dec 7.
Primary care management of osteoarthritis (OA) is variable and often inconsistent with clinical practice guidelines (CPGs). This study aimed to identify and synthesize available qualitative evidence on primary care clinicians' views on providing recommended management of OA.
Eligibility criteria included full reports published in peer-reviewed journals, with data collected directly from primary care clinicians using qualitative methods for collection and analysis. Five electronic databases (MEDLINE, Cochrane Central Register, EMBASE, CINAHL and PsychInfo) were searched to August 2016. Two independent reviewers identified eligible reports, conducted critical appraisal (based on Critical Appraisal Skills Programme (CASP) criteria), and extracted data. Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive new themes. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach was used to determine a confidence profile for each finding.
Eight studies involving approximately 83 general practitioners (GPs), 24 practice nurses, 12 pharmacists and 10 physical therapists, from Australia, France, United Kingdom, Germany and Mexico were included. Four barriers were identified as themes 1) OA is not that serious, 2) Clinicians are, or perceive they are, under-prepared, 3) Personal beliefs at odds with providing recommended practice, and 4) Dissonant patient expectations. No themes were enablers. Confidence ratings were moderate or low.
Synthesising available data revealed barriers that collectively point towards a need to address clinician knowledge gaps, and enhance clinician communication and behaviour change skills to facilitate patient adherence, enable effective conversations and manage dissonant patient expectations.
PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543].
骨关节炎（OA）的初级保健管理存在差异，且常常与临床实践指南（CPG）不一致。本研究旨在识别并综合现有的关于初级保健临床医生对提供OA推荐管理的观点的定性证据。
纳入标准包括在同行评审期刊上发表的完整报告，数据通过定性方法直接从初级保健临床医生处收集并进行分析。检索了五个电子数据库（MEDLINE、Cochrane中央注册库、EMBASE、CINAHL和PsychInfo）至2016年8月。两名独立评审员识别符合条件的报告，进行批判性评价（基于批判性评价技能计划（CASP）标准），并提取数据。三名评审员先独立，然后合作，通过归纳和迭代过程对数据进行综合和解读，以得出新的主题。采用定性研究综述证据可信度（CERQual）方法为每个发现确定可信度概况。
纳入了八项研究，涉及来自澳大利亚、法国、英国、德国和墨西哥的约83名全科医生（GP）、24名执业护士、12名药剂师和10名物理治疗师。确定了四个障碍作为主题：1）OA不那么严重；2）临床医生或认为自己准备不足；3）个人信念与提供推荐的实践不一致；4）患者期望不协调。没有主题是促进因素。可信度评级为中等或低。
综合现有数据揭示了一些障碍，这些障碍共同表明需要解决临床医生的知识差距，提高临床医生的沟通和行为改变技能，以促进患者依从性，进行有效的沟通并管理不协调的患者期望。
PROSPERO（http://www.crd.york.ac.uk/PROSPERO）[2015年11月4日，CRD42015027543]
