让临床指南适用于多种长期疾病患者:从审查单一疾病指南的分析和建议中得出的建议
Sara Pretorius1, Victoria Bartle2, Sue Bellass3,4
1NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK.
BMJ medicine
|February 27, 2026
概括
英国的临床指南承认多种长期疾病,但提供有限的定制支持. 为了更好的患者护理,需要在指导方针制定方面进行改进.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床指南开发 临床指南开发
- 公共卫生政策 公共卫生政策
背景情况:
- 管理多种长期疾病的患者带来了复杂的挑战.
- 现有的临床指导方针往往侧重于单一的疾病,可能会忽视多病症的复杂性.
- 需要评估当前的指导方针是如何针对具有多种长期疾病并存的患者的.
研究的目的:
- 评估英国针对个体健康状况的指导方针在多种长期疾病患者的治疗程度.
- 为准则制定过程提出改进建议,以更好地纳入多病症.
主要方法:
- 2013年至2024年期间,英国国家卫生和护理卓越研究所 (NICE) 开发的56条临床指南的综述.
- 分析的重点是指导方针如何处理共存的条件,区分一致和不一致的条件.
- 审查指南委员会组成,以多样化和纳入患者经验为准则.
主要成果:
- 几乎所有的指导方针 (98%) 提供了一些关于管理指数条件与共存条件的建议,89%提供了一般护理定制指导.
- 然而,只有20%的人明确提到多种长期疾病,没有人有专门的管理部分.
- 根据疾病类别,共存疾病的覆盖范围有很大差异,心理健康指南比癌症或眼睛疾病指南更关注共存疾病.
结论:
- 尽管NICE的指导方针承认多病症,但仍然在很大程度上与疾病有关,为患有多种长期疾病的患者提供了不足的量身定制支持.
- 建议很少考虑共同的条件集群或多种条件的累积影响.
- 建议进行改进,例如更明确的适应指导,交叉条件引用和实践经验的纳入,以提高指导方针的有用性.
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