Saillour-Glénisson Florence, Kret Marion, Domecq Sandrine, Sibé Matthieu, Daucourt Valentin, Migeot Virginie, Veillard David, Michel Philippe
CHU de Bordeaux, Pole de Sante Publique, Service d'Information Medicale, F-33000 Bordeaux, France.
INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.
Int J Qual Health Care. 2017 Aug 1;29(4):579-586. doi: 10.1093/intqhc/mzx074.
To identify managerial and organizational characteristics of multi-specialty medicine wards and individual characteristics of health professionals that are most strongly associated with clinical practice guidelines (CPG) adherence.
Cross-sectional stratified cluster sample design.
Data were gathered from 36 randomly selected multi-specialty medicine wards.
The study population included all health professionals involved in patient care working in the participating wards.
The degree of CPG adherence was measured using clinical vignettes on three topics: pain management, managing heart failure and managing diabetes. Responses from each professional to each clinical case were quantified using a 10-point scale. Managerial and organizational characteristics of medical department and individual characteristics of health professionals were obtained using three questionnaires.
The study sample consisted of 859 professionals (362 orderlies, 361 nurses and 136 physicians). Factors independently and positively associated with CPG adherence were (i) individual factors: low age of professionals, expertise in diabetology and activity in cardiology; (ii) organizational and managerial factors: good understanding between physicians and other personnel; and (iii) structural factors: computer-based test results and prescriptions, presence of medical specialists, inter-department mobility of orderlies, medium-length stay (between 7 and 10 days) and large bed capacity.
Good CPG adherence in general medicine needs institutional dynamism, availability of clinical competence and team culture based on cooperation.
确定与临床实践指南（CPG）依从性最密切相关的多专科医疗病房的管理和组织特征以及卫生专业人员的个人特征。
横断面分层整群抽样设计。
从36个随机选择的多专科医疗病房收集数据。
研究人群包括参与病房中所有参与患者护理工作的卫生专业人员。
使用关于疼痛管理、心力衰竭管理和糖尿病管理三个主题的临床病例 vignettes 来衡量CPG依从程度。每个专业人员对每个临床病例的回答使用10分制进行量化。使用三份问卷获取医疗部门的管理和组织特征以及卫生专业人员的个人特征。
研究样本包括859名专业人员（362名护工、361名护士和136名医生）。与CPG依从性独立且呈正相关的因素有：（i）个人因素：专业人员年龄小、糖尿病专业知识和心脏病学活动；（ii）组织和管理因素：医生与其他人员之间的良好理解；（iii）结构因素：基于计算机的测试结果和处方、医学专家的存在、护工的跨部门流动、中等住院时间（7至10天）和大床位容量。
普通内科良好的CPG依从性需要机构活力、临床能力的可用性以及基于合作的团队文化。
