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中西医结合临床实践指南的可实施性评价

叶紫莹,  田晨,  晏毅龙,  李巧凤,  宁金铃,  李婷婷,  葛龙

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叶紫莹, 田晨, 晏毅龙, 李巧凤, 宁金铃, 李婷婷, 葛龙. 中西医结合临床实践指南的可实施性评价[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2023-0198
引用本文: 叶紫莹, 田晨, 晏毅龙, 李巧凤, 宁金铃, 李婷婷, 葛龙. 中西医结合临床实践指南的可实施性评价[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2023-0198
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YE Ziying, TIAN Chen, YAN Yilong, LI Qiaofeng, NING Jinling, LI Tingting, GE Long. Implementation Evaluation of Clinical Practice Guidelines for Integrative Medicine[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2023-0198
Citation: YE Ziying, TIAN Chen, YAN Yilong, LI Qiaofeng, NING Jinling, LI Tingting, GE Long. Implementation Evaluation of Clinical Practice Guidelines for Integrative Medicine[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2023-0198
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中西医结合临床实践指南的可实施性评价

doi: 10.12290/xhyxzz.2023-0198

  • 1 兰州大学公共卫生学院 循证社会科学研究中心, 兰州 730000;

  • 2 兰州大学公共卫生学院 社会医学与卫生事业管理研究所, 兰州 730000;

  • 3 甘肃省循证医学与临床转化重点实验室, 兰州 730000;

  • 4 世界卫生组织指南实施与知识转化合作中心, 兰州 730000

基金项目: 

中国中医科学院创新基金(CI2021A05502)

详细信息
    通讯作者:

    葛龙,E-mail:gelong2009@163.com

  • 中图分类号: R181.2

Implementation Evaluation of Clinical Practice Guidelines for Integrative Medicine

  • 1 Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China;

  • 2 Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou 730000, China;

  • 3 Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China;

  • 4 WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China

Funds: 

China Academy of Chinese Medical Sciences Innovation Fund (CI2021A05502)

    摘要
  • 摘要: 目的 系统地评价中西医结合临床实践指南的可实施性，为今后提高中西医结合指南可实施性提供参考依据。 方法 检索PubMed、Web of Science、Embase、中国生物医学文献数据库、中国知网和万方数据库，补充检索当当网、中华医学会、中医药管理局、梅斯医学网站、中华中医药学会网站、医脉通、中国中西医结合学会官网和世界中医药联合会官网以获取中西医结合临床实践指南，检索时间范围从建库至2022年12月31日。由4名评价员采用指南可实施性评价工具对纳入指南进行可实施性评价。 结果 共纳入61部中西医结合指南。其中，可实施性非常强的指南9部（14.75%），一般39部（63.93%），较差12部（19.67%）。5个评价领域中,“可及性”“可执行性”两个领域质量较高，“沟通性”“易识别性” “应用性”三个领域相对较差。与2016年之前发布的指南相比，2017—2022年发布的指南在易识别性和应用性领域都有提高。 结论 现有中西医结合临床实践指南的可实施性一般，尚需提高。今后应注重医教研一体化，加大指南宣传力度，加强临床医生的指南应用，加强继续医学教育和培训，以更简洁的形式呈现推荐意见，提升中西医结合指南的可实施性。
    Abstract: Objective This study aims to systematically assess the applicability of the clinical practice guidelines (CPGs) integrating Chinese and Western medicine, thereby providing a reference point for enhancing their future usability. Methods PubMed, Web of Science, Embase， SinoMed, WanFang Data, and CNKI databases were searched for guidelines for integration of Chinese and Western medicine, supplemented by searches of the Dangdang, Chinese Medical Association, Chinese Medicine Administration, MedSci websites, Website of China Association of Chinese Medicine, medlive, Chinese Association of Integrative Medicine and World Federation of Traditional Chinese Medicine Societies from inception to December 31, 2022. Four reviewers independently evaluated the implementability of clinical practice guidelines by using “Clinical Practice Guideline (CPG) implementation evaluation tool”. Results A total of 61 integrative Chinese and Western Medicine guidelines were included. Of the guidelines assessed, 9 guidelines (14.75%) exhibited strong implementability, 39 (63.93%) demonstrated average implementability, and 12 (19.67%) demonstrated poor implementability. Among the 5 domains, the dimensions of "accessibility" and "implementability" were found to be of high quality, while "communication", "ease of identification" and "applicability" were relatively poor. Notably, compared to guidelines published before 2016, those published between 2017-2022 showed improvements in the areas of “identification” and “application”. Conclusion The implementabilityof the existing clinical practice guidelines of the integrative Chinese and Western Medicine is average and needs to be improved. In the future, emphasis should be placed on the integration of medical education and research, increasing the publicity of the guidelines, strengthening the application of the guidelines by clinicians, enhancing continuing medical education and training, presenting recommendations in a more concise form, and improving the implementability of the integrative Chinese and Western Medicine guideline.
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    • 参考文献(30)
  • [1] Institute of Medicine.Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical Practice Guidelines We Can Trust[M]. Washington (DC):National Academies Press, 2011.
    [2] 国务院.国务院关于印发中医药发展战略规划纲要(2016-2030年)的通知[J]. 中华人民共和国国务院公报, 2016, 1547:21-29.
    [3] 陈耀龙, 史乾灵, 赵俊强, 等. 从知到行:跨越指南理论与实践的鸿沟[J]. 协和医学杂志, 2020, 11:746-753.
    [4] 郑丹平. 基于AGREE系列评价工具的中医诊疗指南适用性研究[D].北京:中国中医科学院, 2021:41- 42.
    [5] Zeng L, Li Y, Zhang L, et al. Guideline use behaviours and needs of primary care practitioners in China:a cross-sectional survey[J]. BMJ Open, 2017, 7:e015379.
    [6] Heselmans A, Donceel P, Aertgeerts B, et al. The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines[J]. BMC Fam Pract, 2009, 10:64.
    [7] Martinez-Cannon BA, Soto-Perez-de-Celis E, Erazo Valle-Solis A, et al. Physicians' attitudes and perceived barriers to adherence to the national breast cancer clinical practice guidelines in Mexico:a survey study[J]. Clin Transl Oncol, 2023, 25:151-159.
    [8] Grimshaw J, Eccles M, Thomas R, et al. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998[J]. J Gen Intern Med, 2006, 21:S14-S20.
    [9] Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China:1993-2010[J]. Chin Med J (Engl), 2012, 125:3660-3664.
    [10] 赵国桢, 冯硕, 张霄潇, 等. 中医药临床实践指南:现状和思考[J]. 中国循证医学杂志, 2018, 18:1386-1390.
    [11] 史楠楠, 韩学杰, 刘兴方, 等. 404名中医医师高血压病中医临床实践指南使用情况的调查研究[J]. 中华中医药杂志, 2012, 27:3067-3071.
    [12] Shiffman R N, Dixon J, Brandt C, et al. The GuideLine Implementability Appraisal (GLIA):development of an instrument to identify obstacles to guideline implementation[J]. BMC Med Inform Decis Mak, 2005, 5:23.
    [13] Brouwers MC, Makarski J, Kastner M, et al. The Guideline Implementability Decision Excellence Model (GUIDE-M):a mixed methods approach to create an international resource to advance the practice guideline field[J]. Implement Sci, 2015, 10:36.
    [14] Ierano C, Ayton D, Peel T, et al. Evaluating the implementability of Antibiotic Surgical Prophylaxis guidelines[J]. Infect Dis Health, 2020, 25:11-21.
    [15] Freixa A, Moreira T, Bill O, et al. Implementability of stroke guidelines:a pragmatic comparison between US and European recommendations using eGLIA[J]. Stud Health Technol Inform, 2015, 210:256-260.
    [16] Hill KM, Lalor EE. How useful is an online tool to facilitate guideline implementation? Feasibility study of using eGLIA by stroke clinicians in Australia[J]. Qual Saf Health Care, 2009, 18:157-159.
    [17] 靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价[J]. 中国循证医学杂志, 2022, 22:111-119.
    [18] 潘晓平, 倪宗瓒. 组内相关系数在信度评价中的应用[J]. 华西医科大学学报, 1999(1):62-63, 67.
    [19] Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines:1. Introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol, 2011, 64:383-394.
    [20] 李红艳, 施秀青, 郭静, 等. 临床实践指南实施性促进研究之五:中医/中西医结合临床实践指南与专家共识的实施性评价[J]. 医学新知, 2022, 32:161-169.
    [21] Gagliardi A R. "More bang for the buck":exploring optimal approaches for guideline implementation through interviews with international developers[J]. BMC Health Serv Res, 2012, 12:404.
    [22] Kastner M, Bhattacharyya O, Hayden L, et al. Guideline uptake is influenced by six implementability domains for creating and communicating guidelines:a realist review[J]. J Clin Epidemiol, 2015, 68:498-509.
    [23] Gupta S, Tang R, Petricca K, et al. The Guideline Language and Format Instrument (GLAFI):development process and international needs assessment survey[J]. Implement Sci, 2022, 17:47.
    [24] Jin Y, Li Z, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China:a mixed-method study[J]. BMJ Open, 2019, 9:e026328.
    [25] Wang T, Tan JYB, Liu XL, et al. Barriers and enablers to implementing clinical practice guidelines in primary care:an overview of systematic reviews[J]. BMJ Open, 2023, 13:e062158.
    [26] 陈可冀, 宋军. 病证结合的临床研究是中西医结合研究的重要模式[J]. 世界科学技术, 2006(2):1-5.
    [27] 金志春. 制定中西医结合临床指南应注意的问题[J]. 中西医结合学报, 2008(1):5-8.
    [28] 陈可冀, 蒋跃绒. 中医和中西医结合临床指南制定的现状与问题[J]. 中西医结合学报, 2009, 7:301-305.
    [29] Forsetlund L, O'Brien M A, Forsén L, et al. Continuing education meetings and workshops:effects on professional practice and healthcare outcomes[J]. Cochrane Database Syst Rev, 2021, 9:CD003030.
    [30] Jin YH, Tan LM, Khan KS, et al. Determinants of successful guideline implementation:a national crosssectional survey[J]. BMC Med Inform Decis Mak, 2021, 21:19.
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  • 收稿日期:  2023-04-15
  • 网络出版日期:  2023-06-26

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