Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
Implement Sci. 2020 Nov 25;15(1):101. doi: 10.1186/s13012-020-01056-1.
Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement these guidelines through a variety of strategies. We describe the current status of young resident physician practices towards CPGs and investigate the multiple factors associated with the active use of CPGs, including the physician's knowledge, attitudes, behaviours, CPG-related education received, and the hospital's IT infrastructures. The aim is to identify a more effective point for intervention to promote CPG implementation.
We conducted a questionnaire survey among resident physicians working at 111 hospitals across Japan in 2015 and used results with hospital IT score data collected from a prior survey. Multivariable logistic regression analysis was performed to examine the determinants of frequent use of CPGs (defined at least once per week). The independent variables were selected based on physician demographics, clinical speciality and careers, daily knowledge and behaviour items, CPG-related education received, digital preference, and hospital IT score (high/medium/low), with and without interaction terms.
Responses from 535 resident physicians, at 61 hospitals, were analysed. The median hospital IT score was 6 out of a possible 10 points. Physicians who had learned about CPGs tended to work at hospitals with medium to high IT scores, had easier access to paywalled medical databases, and had better knowledge of the guideline network 'Minds'. In addition, these physicians tended to use CPGs electronically. A physician's behaviour towards using CPGs for therapeutic decision-making was strongly associated with frequent use of CPGs (odds ratio [95% CI] 6.1 [3.6-10.4]), which indicated that a physician's habit strongly promotes CPG use. Moreover, CPG-related education was associated with active use of CPGs (OR1.7 [1.1-2.5]). The interaction effects between individual digital preferences and higher hospital IT score were also observed for frequent CPG use (OR2.9 [0.9-8.8]).
A physician's habitual behaviours, CPG-related education, and a combination of individual digital preference and superior hospital IT infrastructure are key to bridging the gap between the use and implementation of CPGs.
尽管全球范围内频繁更新并持续努力通过各种策略来传播和实施这些指南，但临床实践指南（CPGs）的依从性仍然不足。我们描述了年轻住院医师对 CPG 的实践现状，并调查了与积极使用 CPG 相关的多种因素，包括医生的知识、态度、行为、接受的 CPG 相关教育以及医院的 IT 基础设施。目的是确定更有效的干预点以促进 CPG 的实施。
我们于 2015 年在日本 111 家医院的住院医师中进行了问卷调查，并使用了先前调查中收集的医院 IT 评分数据。采用多变量逻辑回归分析来检查频繁使用 CPG（定义为每周至少使用一次）的决定因素。根据医生的人口统计学、临床专业和职业、日常知识和行为项目、接受的 CPG 相关教育、数字偏好以及医院 IT 评分（高/中/低）选择自变量，包括交互项。
分析了来自 61 家医院的 535 名住院医师的回复。医院 IT 评分中位数为 10 分制中的 6 分。了解 CPG 的医生倾向于在 IT 评分中等到高的医院工作，更容易访问付费医学数据库，并且对指南网络“Minds”的了解更好。此外，这些医生倾向于电子使用 CPG。医生在治疗决策中使用 CPG 的行为与频繁使用 CPG 密切相关（优势比 [95%CI] 6.1 [3.6-10.4]），这表明医生的习惯强烈促进了 CPG 的使用。此外，CPG 相关教育与 CPG 的积极使用相关（OR1.7 [1.1-2.5]）。还观察到个人数字偏好与较高医院 IT 评分之间的交互作用对频繁使用 CPG 有影响（OR2.9 [0.9-8.8]）。
医生的习惯行为、CPG 相关教育以及个人数字偏好与优越医院 IT 基础设施的结合是弥合 CPG 使用和实施差距的关键。
