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

doi:10.12290/xhyxzz.2023-0198

中西医结合临床实践指南的可实施性评价

Implementation Evaluation of Clinical Practice Guidelines for Integrative Medicine

摘要

摘要:
目的应用可实施性评价工具，系统评价中西医结合临床实践指南(下文简称“指南”)的质量，为提高我国中西医结合指南的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，补充检索中华医学会、中医药管理局、梅斯医学、中华中医药学会、当当网、医脉通、中国中西医结合学会和世界中医药联合会官网，以获取中西医结合指南，检索时间范围为建库至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40部(65.57%)，较差12部(19.67%)。5个评价领域中, “可及性”和“可执行性”领域的质量较高，“沟通性”“易识别性”和“应用性”领域相对较低。相较于2006—2016年发布的指南，2017—2022年发布的指南在“易识别性”和“应用性”领域均有提高。
结论现有中西医结合指南的可实施性一般，有待进一步提高；今后应注重医教研一体化，加大对指南的宣传力度，加强继续医学教育和培训，以更简洁的形式呈现指南推荐意见，促进临床医生对指南的应用，提升中西医结合指南的可实施性。

Abstract:
Objective To systematically assess the applicability of the clinical practice guidelines (CPGs) integrating Chinese and western medicine, thereby providing reference for enhancing their future usability.
Methods PubMed, Web of Science, Embase, SinoMed, WanFang Data, and CNKI databases were searched for guidelines for the integration of Chinese and western medicine. Supplementary searches of Chinese Medical Association, Chinese Medicine Administration, MedSci websites, Website of China Association of Chinese Medicine, Medlive, Website of Dangdang, Chinese Association of Integrative Medicine and World Federation of Traditional Chinese Medicine Societies were conducted. The search time frame was from inception of the databases 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, 40(65.57%) 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 those of "communication", "ease of identification" and "applicability" were relatively poor. Notably, compared to guidelines published between 2006—2016, those published between 2017—2022 showed improvements in the areas of "identification" and "application".
Conclusions 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, publicity of the guidelines, continuous medical education and training, a more concise form of recommendations, application of the guidelines by clinicians, and the implementability of the integrative Chinese and western medicine guideline.

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