Conroy M, Shannon W
Department of General Practice, Royal College of Surgeons in Ireland, Dublin.
Br J Gen Pract. 1995 Jul;45(396):371-5.
In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implementation, the effectiveness of guidelines in changing practice and, in particular, the strategies needed to implement clinical guidelines in general practice. Mechanisms of behavioural change that have been recognized as being important for implementation are also discussed. If implementation strategies are not treated as an integral part of the development process then clinical guidelines may fail to achieve their potential in changing clinical practice.
近年来，临床指南的制定越来越受到医学教育工作者和参与标准制定者的关注，并且在中央和地方层面都已启动。这篇综述文章概述了医学实践中临床指南实施方面的当前知识状况。它探讨了当前指南辩论的主要方面，例如临床自主性和医生自主权、指南实施中所有权的重要性、指南在改变实践方面的有效性，特别是在全科医疗中实施临床指南所需的策略。还讨论了已被认为对实施很重要的行为改变机制。如果实施策略不被视为制定过程的一个组成部分，那么临床指南可能无法在改变临床实践中发挥其潜力。
