Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto M5B 1W8, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada.
Diabetes Res Clin Pract. 2018 Jun;140:314-323. doi: 10.1016/j.diabres.2018.02.041. Epub 2018 Apr 4.
Implementation of clinical practice guideline (CPG) into clinical practice remains limited. Using the Knowledge-To-Action framework, a guideline dissemination and implementation strategy for the Canadian Diabetes Association's 2013 CPG was developed and launched to clinicians and people with diabetes.
The RE-AIM framework guided evaluation of this strategy clinician; we report here one aspect of the effectiveness dimension using mixed methods. We measured impact of the strategy on clinican knowledge and behaviour change constructs using evaluation forms, national online survey and individual interviews.
After attending a lecture, clinician confidence (n = 915) increased (3.7(SD 0.7) to 4.5 (SD 0.6) on a 5-point scale (p < 0.001)), with 55% (n = 505) intending to make a practice change (e.g. clinical management regarding glycemic control). Ninety-four percent of survey respondents (n = 907) were aware of the guidelines, attributed to communications from professional associations, continuing professional development events, and colleagues. Forty to 98% of respondents (total n 462-485) were correct in their interpretation of CPG messages, and 33-65%(total n 351-651) reported that they had made changes to their practice. Interviews with 28 clinicians revealed that organizational credibility, online access to tools, clarity of tool content, and education sessions facilitated uptake; lack of time, team-based consensus, and seamless integration into care and patient complexity were barriers.
The complexity of diabetes care requires systemic adoption of organization of care interventions, including interprofessional collaboration and consensus. Augmenting our strategy to include scalable models for professional development, integration of guidelines into electronic medical records, and expansion of our target audience to include health care teams and patients, may optimize guideline uptake.
临床实践指南（CPG）在临床实践中的实施仍然有限。使用知识转化框架，为加拿大糖尿病协会 2013 年 CPG 制定并推出了一种向临床医生和糖尿病患者传播和实施指南的策略。
RE-AIM 框架指导了对该策略的临床医生评估；我们在这里报告有效性维度的一个方面，使用混合方法。我们使用评估表、全国在线调查和个人访谈来衡量该策略对临床医生知识和行为改变结构的影响。
在参加讲座后，临床医生的信心（n=915）增加（从 5 分制的 3.7（SD 0.7）增加到 4.5（SD 0.6）（p<0.001）），55%（n=505）打算进行实践改变（例如，血糖控制方面的临床管理）。94%的调查受访者（n=907）知道这些指南，这归因于专业协会、继续职业发展活动和同事的沟通。40%至 98%的受访者（总 n=462-485）对 CPG 信息的解释是正确的，33%-65%（总 n=351-651）报告他们已经对自己的实践进行了改变。对 28 名临床医生的访谈显示，组织可信度、在线获取工具、工具内容的清晰度以及教育课程促进了采用；缺乏时间、基于团队的共识以及无缝整合到护理和患者复杂性中是障碍。
糖尿病护理的复杂性要求系统地采用护理干预措施，包括跨专业合作和共识。扩大我们的策略，包括可扩展的专业发展模式、将指南整合到电子病历中，并将我们的目标受众扩展到包括医疗保健团队和患者，可能会优化指南的采用。
