Hutchinson A
School of Health and Related Research, University of Sheffield, UK.
J Qual Clin Pract. 1998 Mar;18(1):63-73.
There are a number of technical and professional challenges to the use of clinical practice guidelines in the United Kingdom. Until recently, many guidelines have been consensus-based rather than being explicitly linked to evidence of effectiveness and have also been of variable quality. Moreover, clarity of purpose has been lacking with some guidelines being developed as a means of limiting access to secondary care rather than as a means of assisting clinical decision-making. Implementation of new research into practice and of clinical practice guideline recommendations shares many of the same barriers to changing clinician behaviour. Without local support systems to assist with implementation, including clinical audit programmes and methods of feeding back information on current practice, it is unlikely that guidelines will change practice in the majority of clinicians. Progress on the implementation of guidelines in the British National Health Service is discussed.
在英国，临床实践指南的应用面临诸多技术和专业方面的挑战。直到最近，许多指南都是基于共识制定的，而非与有效性证据明确挂钩，且质量参差不齐。此外，一些指南缺乏明确的目的，其制定是为了限制二级医疗服务的获取，而非辅助临床决策。将新研究成果应用于实践以及实施临床实践指南建议，在改变临床医生行为方面面临许多相同的障碍。如果没有当地的支持系统来协助实施，包括临床审计项目以及反馈当前实践信息的方法，那么指南就不太可能改变大多数临床医生的行为。本文讨论了英国国民医疗服务体系中指南实施的进展情况。
