Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
Prim Health Care Res Dev. 2023 May 2;24:e34. doi: 10.1017/S146342362300021X.
Clinical judgement in primary care is more often decisive than in the hospital. Clinical decision rules (CDRs) can help general practitioners facilitating the work-through of differentials that follows an initial suspicion, resulting in a concrete 'course of action': a 'rule-out' without further testing, a need for further testing, or a specific treatment. However, in daily primary care, the use of CDRs is limited to only a few isolated rules. In this paper, we aimed to provide insight into the laborious path required to implement a viable CDR. At the same time, we noted that the limited use of CDRs in primary care cannot be explained by implementation barriers alone. Through the case study of the Oudega rule for the exclusion of deep vein thrombosis, we concluded that primary care CDRs come out best if they are tailor-made, taking into consideration the specific context of primary health care. Current CDRs should be evaluated frequently, and future decision rules should anticipate the latest developments such as the use of point-of-care (POC) tests. Hence, such new powerful diagnostic CDRs could improve and expand the possibilities for patient-oriented primary care.
在初级保健中，临床判断往往比在医院更具决定性。临床决策规则 (CDR) 可以帮助全科医生在初步怀疑后更轻松地进行鉴别诊断，从而制定具体的“行动方案”：无需进一步检查即可排除、需要进一步检查或特定治疗。然而，在日常初级保健中，CDR 的使用仅限于少数孤立的规则。在本文中，我们旨在深入了解实施可行 CDR 所需的艰苦过程。同时，我们注意到 CDR 在初级保健中的有限使用不能仅仅用实施障碍来解释。通过 Oudega 排除深静脉血栓形成的规则案例研究，我们得出结论，如果考虑到初级卫生保健的特定背景，量身定制的初级保健 CDR 效果最佳。应定期评估当前的 CDR，并预测未来的决策规则，例如使用即时检测 (POC) 测试。因此，这些新的强大的诊断 CDR 可以改善和扩大以患者为中心的初级保健的可能性。
