Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Mult Scler Relat Disord. 2022 Jan;57:103434. doi: 10.1016/j.msard.2021.103434. Epub 2021 Dec 3.
In May 2021, a new guideline on the diagnosis and treatment of multiple sclerosis and related disorders was released in Germany. Since the success of a guideline depends on how it integrates into everyday clinical practice, the German Society for Neurology (DGN) has launched a multimethod implementation project. Here we report on the results based on the consultation version of the guideline.
We used qualitative and quantitative data analyses to capture the nature and extent of barriers and facilitating factors to the implementation. We centered on the guideline's chapter A on diagnosis, relapse therapy, and immunotherapy of multiple sclerosis. We performed nine online focus group discussions and a web-based survey and analyzed emails and letters with comments from stakeholders and independent parties that were sent spontaneously or by invitation.
94 neurologists answered the survey, and ≥70% agreed with the recommendations of the guideline on each major content topic. Barriers to implementation were detected in group discussions and written input. The most controversial issues of the guideline were "early treatment", "criteria for starting or switching therapy", "stepwise escalation versus early aggressive treatment", "classification of drugs into three categories of efficacy" and the scenarios on "treatment cessation". Some appreciated the highly structured recommendations, but others felt that the guideline restricts the free choice of therapy, or they were afraid of recourse claims. Some considered the guideline as too cautious regarding treatment initiation, possibly delaying necessary therapies. Others appreciated that conflicts of interests of the guideline's authoring group were minimized and thought that the new guideline is clearer, more extensive and practical.
In contrast to the survey, feedback in the focus group discussions and from individuals was diverse and sometimes more critical. Based on the overall feedback rate of about 250 people in relation to the number of 6500 board-certified neurologists in Germany, the overall appreciation of the guideline can only be considered as an indicator and not proof of acceptance. Results of this analysis were incorporated into several adjustments to the final guideline of 2021. Since the guideline is to be updated regularly under the auspices of a "living guideline", active interaction with users will continue to matter and help to improve it.
2021 年 5 月，德国发布了一份关于多发性硬化症及相关疾病诊断和治疗的新指南。由于指南的成功取决于其在日常临床实践中的融入程度，德国神经病学会（DGN）已启动了一项多方法实施项目。在此，我们报告基于指南征求意见稿的结果。
我们使用定性和定量数据分析来捕捉实施过程中障碍和促进因素的性质和程度。我们以指南中关于多发性硬化症诊断、复发治疗和免疫治疗的 A 章为重点。我们进行了 9 次在线焦点小组讨论和一次基于网络的调查，并分析了利益相关者和独立方自发或应邀发送的电子邮件和信件中的意见。
94 名神经科医生回答了调查，≥70%的人对指南每个主要内容主题的建议表示赞同。在小组讨论和书面意见中发现了实施障碍。指南中最具争议的问题是“早期治疗”、“开始或转换治疗的标准”、“逐步升级与早期积极治疗”、“将药物分为三类疗效”以及“停止治疗”的场景。一些人赞赏高度结构化的建议，但另一些人认为该指南限制了治疗选择的自由，或者他们担心诉诸法律索赔。一些人认为该指南在开始治疗方面过于谨慎，可能会延迟必要的治疗。另一些人赞赏该指南最大限度地减少了指南编写小组的利益冲突，并认为新指南更清晰、更广泛、更实用。
与调查相比，焦点小组讨论和个人的反馈意见多种多样，有时更为批评。基于与德国 6500 名认证神经科医生相比，约 250 人对该指南的总体反馈率，对该指南的总体赞赏只能被视为一种指标，而不能证明其被接受。对这些分析结果进行了综合考虑，对 2021 年的最终指南进行了一些调整。由于该指南将在“活指南”的主持下定期更新，因此与用户的积极互动将继续发挥重要作用，并有助于对其进行改进。
