Woolf S H
Medical College of Virginia School of Medicine, Richmond, USA.
Am Fam Physician. 1995 May 1;51(6):1455-63.
Practice guidelines that specify how to treat medical conditions and perform procedures are appearing with greater frequency in the medical literature. Their use by managed care plans, hospitals and government programs is expected to affect the practice of medicine substantially in the coming years. This article reviews the key information that family physicians should have in order to evaluate and use practice guidelines effectively: how they are developed; how they differ from textbooks, review articles and other sources of expert consultation; whether they promote "cookbook medicine"; when to modify one's clinical practice in response to new guidelines, and how to cope with conflicting recommendations. Practice guidelines can improve the quality of care by summarizing current evidence and expert opinion, but they can also reduce the quality of care if the recommendations are poorly supported by scientific evidence and clinical reasoning. Economic and medicolegal concerns can also influence the potential benefits and harms of practice guidelines. Since hundreds of practice guidelines are anticipated to be developed in the coming years, family physicians should become informed consumers of guidelines, avoid accepting them on face value, and ask specific questions to judge their quality.
明确如何治疗疾病和实施医疗程序的实践指南在医学文献中出现的频率越来越高。预计管理式医疗计划、医院和政府项目对其的使用在未来几年将对医学实践产生重大影响。本文回顾了家庭医生为有效评估和使用实践指南应掌握的关键信息：它们是如何制定的；它们与教科书、综述文章及其他专家咨询来源有何不同；它们是否会助长“菜谱式医学”；何时应根据新指南调整临床实践，以及如何应对相互冲突的建议。实践指南可以通过总结当前证据和专家意见来提高医疗质量，但如果这些建议缺乏科学证据和临床推理的有力支持，它们也可能降低医疗质量。经济和法医学方面的考量也会影响实践指南的潜在益处和危害。由于预计未来几年将制定数百项实践指南，家庭医生应成为明智的指南使用者，避免仅凭表面价值接受它们，并提出具体问题以判断其质量。
