Puech M, Ward J, Hirst G, Hughes A M
Needs Assessment and Health Outcomes Unit, Central Sydney Area Health Service, Newtown, Australia.
Int J Qual Health Care. 1998 Aug;10(4):339-43. doi: 10.1093/intqhc/10.4.339.
Systematic reviews demonstrate that local initiatives are vital to implement nationally developed clinical practice guidelines. Evidence-based guidelines on the management of lower urinary tract symptoms in men were launched by the National Health and Medical Research Council in Sydney in April 1997. A study was conducted through interviews to establish patterns of care in the catchment area before the guidelines were implemented and general practitioners were surveyed in order to ascertain the most useful strategies for local implementation.
A four-page questionnaire asked respondents to rate nine items about guideline dissemination; six items relating to the marketing of the guidelines and 15 implementation strategics: conventional educational activities (six); innovative educational strategies (four); quality improvement approaches (two) and patient-based approaches (three).
Sydney, Australia.
Eighty-three randomly selected general practitioners (50 males; 33 females).
Eighty-three out of 108 surveys were returned (77%). Respondents placed high value upon endorsement by eminent individuals and organizations other than the organization developing the guidelines; this was likely to gain their initial attention. One hundred per cent of respondents would be encouraged to use the guidelines if they were promoted as improving quality of care. Implementation strategies preferred by respondents included small group continuing education with a urologist and a general practitioner as a facilitator, lectures and patient education materials. Internet access, interactive computer systems, academic detailing' and distance education modules were of least interest.
Our method is feasible as a first step in planning local dissemination and implementation for national guidelines. While useful in identifying preferred strategies, its longer-term predictive validity for improving patient outcomes through better guideline implementation needs to be established.
系统评价表明，地方举措对于实施国家制定的临床实践指南至关重要。1997年4月，澳大利亚国家卫生与医学研究委员会在悉尼发布了关于男性下尿路症状管理的循证指南。在指南实施前，通过访谈开展了一项研究，以确定该集水区的护理模式，并对全科医生进行了调查，以确定地方实施的最有效策略。
一份四页的问卷要求受访者对有关指南传播的九个项目、与指南推广相关的六个项目以及15种实施策略进行评分：传统教育活动（六种）；创新教育策略（四种）；质量改进方法（两种）和基于患者的方法（三种）。
澳大利亚悉尼。
随机选择的83名全科医生（50名男性；33名女性）。
108份调查问卷中有83份被收回（77%）。受访者高度重视除制定指南的组织之外的知名个人和组织的认可；这可能会引起他们的初步关注。如果宣传指南能提高护理质量，100%的受访者会受到鼓励使用这些指南。受访者首选的实施策略包括由一名泌尿科医生和一名全科医生作为促进者的小组继续教育、讲座和患者教育材料。互联网接入、交互式计算机系统、学术推广和远程教育模块最不受关注。
我们的方法作为规划国家指南的地方传播和实施的第一步是可行的。虽然有助于确定首选策略，但需要确定其通过更好地实施指南来改善患者结局的长期预测有效性。
