Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
John Wall's Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
BMJ Open. 2024 Jun 18;14(6):e085723. doi: 10.1136/bmjopen-2024-085723.
Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented.
Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement.
419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement.
The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care.
尽管已经开展了研究以探寻如何将循证建议有效地应用于临床实践，但临床实践指南的委托和制定缺乏标准化，这可能导致实施过程中的不一致和差距。本研究旨在确定英国范围内值得制定指南的肾脏护理相关主题应如何进行选择、优先排序、设计和实施。
采用改良 Delphi 方法，来自英国各地的肾脏保健多学科专家小组就选择、制定和实施肾脏病指南相关问题制定了 35 条陈述。使用在线调查来确定对这些陈述的共识；共识阈值定义为 75%的同意率。
共收到 419 份回复。在 364 名医疗保健从业者（HCP）中，大多数人在其岗位上拥有超过 20 年的经验（n=123），大多数受访者为肾病学家（n=95）。在 55 名非临床受访者中，大多数是患有肾脏疾病的人（n=41），其余的是他们的照顾者或家人。参与者来自英格兰、北爱尔兰、苏格兰和威尔士各地。在 35 条陈述中，HCP 达成了 32/35 条陈述的共识，其中 28 条陈述达成了≥90%的共识。在 20 条陈述中，患者和患者代表达成了共识，其中 13 条陈述达成了≥90%的共识。
目前的结果为改进指南的选择、设计和实施提供了基础，提出了六条建议。实施这些建议将有助于提高临床指南的可及性和参与度，为英国肾脏护理中最佳实践的持续发展做出贡献。
