Fletcher R H
Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA 02215, USA.
Schweiz Med Wochenschr. 1998 Nov 28;128(48):1883-8.
Clinical practice guidelines are an increasing part of efforts to improve the quality and reduce the cost of health care. They are recommendations for the evidence-based care of average patients, not rules for all patients. At best they are developed by panels representing a wide array of expertise and experience related to the clinical question, are based on comprehensive, critical review of scientific evidence, make clear how value judgments affect recommendations, and take into account all of the issues bearing on clinical decisions, such as effectiveness, risk, convenience, cost, cost-effectiveness, and the resources needed to carry out the recommendations. Physicians have a mixed opinion of guidelines, believing they are both useful summaries to improve the quality of care and potential tools to judge and control them. Although guidelines may point out the best research evidence to guide the care of average patients, they are not a substitute for clinical judgment, which should be applied to each individual patient.
临床实践指南在提高医疗质量和降低医疗成本的努力中所占比重日益增加。它们是针对普通患者循证医疗的建议，而非适用于所有患者的规则。充其量，它们是由代表与临床问题相关的广泛专业知识和经验的小组制定的，基于对科学证据的全面、批判性审查，明确价值判断如何影响建议，并考虑到所有与临床决策相关的问题，如有效性、风险、便利性、成本、成本效益以及实施建议所需的资源。医生对指南看法不一，认为它们既是提高医疗质量的有用总结，也是评判和控制医疗的潜在工具。尽管指南可能指出最佳研究证据以指导普通患者的治疗，但它们不能替代临床判断，临床判断应适用于每一位患者。
