Rodríguez María Victoria, Prieto Florencia, Pantoja Tomás, Letelier Francisco
Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Massachusetts Institute of Technology, Boston, USA.
Rev Med Chil. 2019 May;147(5):602-611. doi: 10.4067/S0034-98872019000500602.
Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals.
To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform.
An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents.
Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use.
The identified factors associated with CPG use should be considered in future guideline design.
临床实践指南(CPG)可促进医疗保健质量的提高和平等性,并且有可能改善患者的治疗效果。然而,其实施受到多种因素的阻碍,包括一些与医疗保健专业人员相关的因素。
评估初级保健医生对智利卫生部在卫生部门改革背景下制定的CPG的看法和态度。
向智利1264名初级保健医生发送了经过改编的“对临床实践指南的知识、看法和态度”调查问卷,354人完整作答。分析评估了对CPG的态度、其在初级保健中的使用情况以及与受访者社会人口统计学特征的关系。
82%的受访者查阅了指南流程图,85%查阅了其在线版本。证据水平分类和推荐强度使70%和64%的受访者对指南产生了高度信任。85%的人认为CPG有助于规范临床实践。63%的受访者认为阻碍CPG使用的最主要障碍是缺乏简短、简单且易于获取的形式。计划行为理论的三个维度(对行为的态度、主观规范和感知行为控制)与更高频率的指南使用相关。年龄较大且非智利籍与较低的使用频率相关。
未来指南设计应考虑与CPG使用相关的已确定因素。