为什么医生不遵循临床实践指南? 一个改善的框架
M D Cabana1, C S Rand, N R Powe
1Department of Pediatrics, Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, MD, USA. mcabana@umich.edu
JAMA
|October 27, 1999
概括
医生遵守临床实践指南受到各种因素的限制,包括意识,同意和外部障碍. 了解这些障碍对于改善医疗保健质量和医生实践至关重要.
科学领域:
- 医疗实践和质量改善
- 医疗服务研究 医疗服务研究
- 医生行为研究研究医生行为研究.
背景情况:
- 临床实践指南旨在规范护理,但往往无法改变医生的行为.
- 对于影响医生采用指南的具体因素的理解有限.
研究的目的:
- 系统地审查和识别阻碍医生遵守临床实践指南的障碍.
主要方法:
- 在MEDLINE,ERIC和HealthSTAR数据库 (1966-1998) 中进行了全面的文献搜索.
- 选择了76项相关研究,并对报告的指南遵守障碍进行了分析.
- 障碍物根据它们对医生的知识,态度和行为的影响而分类.
主要成果:
- 在76项研究中的120项调查中,确定了293个潜在障碍.
- 常见的障碍包括缺乏意识 (46),熟悉 (31),同意 (33),自我有效性 (19),结果预期 (8),克服实践惯性 (14),以及外部绩效障碍 (34).
- 大多数调查 (58%) 只关注一种障碍.
结论:
- 遵守指南的障碍是特定于环境的,限制了改进策略的概括性.
- 这一审查为诊断不遵守的原因和制定有针对性的干预措施提供了一个框架.
- 需要进一步的研究来解决医生遵守指南的多面性质.
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