MacPherson Naomi, Norman Kimberley, Gunatillaka Nilakshi, Yao Alexa, Nielsen Suzanne, Sturgiss Elizabeth
School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
Eastern Health Clinical School, Monash University, Melbourne, Australia.
J Eval Clin Pract. 2025 Feb;31(1):e14320. doi: 10.1111/jep.14320.
Clinical practice guidelines (CPGs) are moving toward greater consideration of population-level differences, like health inequities, when creating management recommendations. CPGs have the potential to reduce or perpetuate health inequities. The intrinsic design factors of electronic interfaces that contain CPGs are known barriers to guideline use. There is little existing guidance on supporting the uptake of equity-specific recommendations within CPGs by end users.
To investigate (1) How do General Practitioners (GPs) use Therapeutic Guidelines to adapt their clinical management for disadvantaged populations and do they support equity recommendations in this CPG? (2) How could Therapeutic Guidelines embed health equity information into their guidelines?
The Therapeutic Guidelines was used as a case study as it is the most frequently used CPG in Australian healthcare settings. We employed descriptive qualitative methods, focused on semistructured interviews with 17 eligible GPs. Interviews were structured around four case studies that initially explored the management of a patient from the general population, with their details then changed so they belonged to a disadvantaged population. We used a 'think aloud' interview technique to explore the clinician's application of CPGs.
Three themes were developed relating to: (1) GPs agree that health equity information needs to be intentionally included in guidelines and should focus on disadvantaged subgroups to support their clinical decision-making, (2) GPs want CPGs to include equity information which is relevant to the purpose and use of each guideline, acknowledging that other clinical aids could provide additional information when needed, (3) GPs want clearer signposting of information within guidelines to help navigation of key sections, highlighting the utility of symbols, colours and dropdown functions.
This research extends existing literature by showing that including equity information tailored to the articulated purpose of each CPG, as perceived by end users, may maximise uptake. Our outlined strategies could be used by CPG developers to make equity-focused management recommendations more accessible. This may increase the implementation of equity-focused recommendations by clinicians, supporting current primary care strategies in achieving more equitable outcomes.
临床实践指南（CPG）在制定管理建议时，正朝着更多地考虑人群层面差异（如健康不平等）的方向发展。CPG有可能减少或延续健康不平等。包含CPG的电子界面的内在设计因素是指南使用的已知障碍。目前几乎没有关于支持终端用户采纳CPG中针对公平性的建议的指导意见。
调查（1）全科医生（GP）如何使用治疗指南来调整其对弱势群体的临床管理，以及他们是否支持该CPG中的公平性建议？（2）治疗指南如何将健康公平信息纳入其指南？
以治疗指南作为案例研究，因为它是澳大利亚医疗环境中最常用的CPG。我们采用描述性定性方法，重点对17名符合条件的全科医生进行半结构化访谈。访谈围绕四个案例研究展开，最初探讨对普通人群中一名患者的管理，然后改变其细节，使其属于弱势群体。我们采用“边思考边说”的访谈技巧来探究临床医生对CPG的应用。
形成了三个主题，分别是：（1）全科医生一致认为，健康公平信息需要有意纳入指南，且应关注弱势群体亚组以支持其临床决策；（2）全科医生希望CPG包含与每个指南的目的和用途相关的公平信息，同时承认在需要时其他临床辅助工具可提供额外信息；（3）全科医生希望指南中的信息有更清晰的标识，以帮助导航关键部分，强调符号、颜色和下拉功能的实用性。
本研究通过表明纳入终端用户所认为的针对每个CPG明确目的量身定制的公平信息可能会最大限度地提高采纳率，扩展了现有文献。我们概述的策略可供CPG开发者使用，以使以公平为重点的管理建议更易于获取。这可能会增加临床医生对以公平为重点的建议的实施，支持当前初级保健策略实现更公平的结果。
