是指导方针还是思维路线? - 在德国初级保健中实施新的CKD指南
Konrad Laker1, Tim Bothe2, Natalie Ebert2
1Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. konrad.laker@charite.de.
实施慢性病 (CKD) 指南的障碍包括德国全科医生的低优先级感知和患者理解不足. 改进指导方针的设计,并将其整合到决策支持系统中,可以提高采用率.
科学领域:
- 初级医疗保健医学 一级医疗保健医学
- 临床指导方针的实施
- 腎臟病學的實踐
背景情况:
- 临床指南对于改善初级保健中的慢性病 (CKD) 管理至关重要.
- 德国全科医生和家庭医生学院 (DEGAM) 于2019年发布了第一份针对德国全科医生的CKD指南.
研究的目的:
- 在全科医生 (GPs) 中确定实施DEGAM CKD指南的障碍和推动因素.
- 根据确定的实施挑战和成功情况,为指南的更新提供信息.
主要方法:
- 与柏林和勃兰登堡的全科医生进行了17次半结构面试.
- 按照梅林的方法,使用定性内容分析来分析采访成绩单.
主要成果:
- 重要的障碍包括慢性病的临床优先级低,机会成本和患者理解不足.
- 一般医生建议的推动因素是改进图形设计和集成到临床决策支持系统中.
- 一般医生主要依靠与专家进行非正式沟通来管理CKD,很少咨询指南.
结论:
- 在患者咨询期间,指南并未被用作逐步的决策辅助工具,这是一个关键障碍.
- 初级和中等保健之间的非正式沟通是德国基于证据的CKD信息的重要道.
- 实施举措应侧重于加强初级中等护理关系,以便更好地采用指南.
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