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一般医生和通过指南进行管理控制:对其对其实践的影响的定性研究
Jens Lundegård1,2, Åsa Grauman3, Niklas Juth3
1Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. jens.lundegard@uu.se.
BMC primary care
|January 10, 2026
概括
瑞典的全科医生 (GPs) 发现指南是有益的,但报告了对工作量,灵活性和未充分使用不可衡量的技能的负面影响. 这些压力可能会损害工作环境和医疗保健质量.
科学领域:
- 一般实践 一般实践
- 医疗保健管理的管理
- 基于证据的医学基于证据的医学.
背景情况:
- 医疗管理和基于证据的医学 (EBM) 在一般实践中增加了指导方针驱动的管理.
- 在了解这些发展对瑞典全科医生的影响方面存在差距.
研究的目的:
- 探索瑞典GP与指南管理的关系.
- 调查指南对日常实践和工作环境的影响.
- 了解医生对实施指南的后果的思考.
主要方法:
- 半结构化面对面采访,在2024年与瑞典11名全科医生进行面对面采访.
- 对转录的采访数据进行主题分析.
主要成果:
- 出现了三个紧张主题: (1) 雄心勃勃与负面的副作用 (增加工作量,减少灵活性), (2) 推广可衡量的知识而不是不可衡量的知识,冒着专业技能未充分使用的风险,以及 (3) 珍视自主性,有时放弃临床自由裁量权.
- 潜在的副作用包括工作环境恶化,护理分散,以及难以测量的领域的质量下降.
结论:
- 准则管理提供了好处,但也对护理质量和工作环境产生了不利影响.
- 虽然通过复杂的指导方针组织医疗保健似乎是衡量结果的逻辑,但决策者和开发人员必须承认潜在的副作用.
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