Hungin A P, Rubin G P, Russell A J, Convery B
Northern Primary Care Research Network (NoReN), Health Centre, Eaglescliffe, Stockton on Tees.
Br J Gen Pract. 1997 May;47(418):275-9.
There is a paucity of published guidelines on managing dyspepsia in general practice. Existing guidelines emphasize the role of investigations and drugs rather than management approaches. Focus groups are a means of uncovering the way in which the participants think and work in the pragmatic-setting, and have not previously been formally used in creating guidelines.
To develop guidelines for the management of dyspepsia and to assess the use of focus groups of general practitioners (GPs) in order to do so.
Initial evidence-based guidelines were proposed by a group of four GPs with an audit facilitator, and used for discussion in three focus groups using a standard format. An anthropological analysis of the proceedings led to modifications of the original guidelines, based on knowledge, perceptions and attitudes. The study was set in three distinct locations involving 30 GPs. The outcome measures consisted of feedback, categorized by types of responses, from the analysis of the focus groups and the creation of guidelines.
The resulting guidelines were patient centred and based on the principles of good consultation. They encompassed patients' fears and doctors' clinical uncertainties, and allowed flexibility in the individual patient's management. The focus group methodology exposed a substantial number of GPs to guideline development, and had the added benefits of dissemination, peer review and educational challenge.
It was possible to develop guidelines for dyspepsia using focus groups. The methodology had the added benefits of ownership, peer review, exposure of educational gaps and locality factors, and dissemination of good practice. It included steps from evidence review to implementation strategies. The development of this technique could lead to a strategy towards the creation and application of evidence-based and professionally acceptable clinical guidelines and practice on a locality basis nationally.
关于全科医疗中消化不良管理的已发表指南匮乏。现有指南强调检查和药物的作用，而非管理方法。焦点小组是一种揭示参与者在实际环境中的思维和工作方式的手段，此前尚未正式用于制定指南。
制定消化不良管理指南，并评估全科医生焦点小组在其中的应用。
由四名全科医生和一名审计协调员组成的小组提出初步的循证指南，并用于三个焦点小组的讨论，采用标准格式。对讨论过程进行人类学分析，基于知识、认知和态度对原始指南进行修改。该研究在三个不同地点开展，涉及30名全科医生。结果指标包括焦点小组分析和指南制定过程中按反应类型分类的反馈。
最终形成的指南以患者为中心，基于良好问诊原则。涵盖了患者的担忧和医生的临床不确定性，并允许在个体患者管理中具有灵活性。焦点小组方法使大量全科医生参与到指南制定中，还具有传播、同行评审和教育挑战等额外益处。
利用焦点小组制定消化不良指南是可行的。该方法具有诸多额外益处，包括自主性、同行评审、暴露教育差距和地区因素以及传播良好实践。它涵盖了从证据审查到实施策略的各个步骤。这项技术的发展可能会形成一种在全国范围内基于地区创建和应用循证且专业可接受的临床指南及实践的策略。
