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首页> 外文期刊>Journal of Health Services Research & Policy >General practitioners' uptake of clinical practice guidelines: a qualitative study
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General practitioners' uptake of clinical practice guidelines: a qualitative study

机译：全科医生采用临床实践指南：定性研究

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Objective: To explain recent rapid audited change in the uptake of locally implemented, evidence-based clinical guidelines for asthma and angina in primary care. nnMethods: A case study of primary care in two matched, adjacent districts in Northern England, focusing on a stratified random sample of 49 general practitioners (GPs) from eight primary care groups. Data were collected from three cycles of mainly qualitative interviews carried out at six-monthly intervals, before and after the dissemination of local guidelines and after audit data were gathered. Interviews examined attitudes, awareness and impact of locally disseminated asthma and angina guidelines and the subsequent audit. Audit data on guideline uptake were also available from a parallel study. nnResults: The rapid increase in guideline uptake observed in both intervention and control groups was not explained by individual practitioners or practice factors. The findings are attributed to GPs' awareness of policies for evidence-based medicine, of new health service institutions and of the clinical governance activities of primary care groups. Behaviour change reflects GPs' decisions about what to record in case notes as well as their clinical decisions, so that findings may reflect changing perceptions about accountability rather than about preferred treatment regimes. nnConclusions: Guideline production and dissemination is best seen in the broader context of policy change. Studies of guideline implementation should report before and after data and incorporate significant qualitative components in order to identify important contextual factors.
机译：目的：解释最近快速审计的变化对初级保健中哮喘和心绞痛的局部实施，循证医学指南的吸收。 nn方法：对英格兰北部两个相匹配的相邻地区的初级保健进行案例研究，重点是对来自八个初级保健组的49位全科医生（GP）进行分层随机抽样。在分发本地指南之前和之后以及在收集审计数据之后，从六个月间隔的三个主要定性访谈周期中收集数据。访谈检查了当地传播的哮喘和心绞痛指南的态度，意识和影响以及随后的审核。平行研究也提供了有关指南吸收的审计数据。结果：在干预组和对照组中观察到的指南摄取量的快速增加并未由个体从业者或实践因素来解释。这些发现归因于全科医生对循证医学政策，新卫生服务机构以及初级保健团体的临床治理活动的意识。行为改变反映了全科医生对病例记录的决定以及他们的临床决定，因此调查结果可能反映出人们对问责制而不是首选治疗方案的看法不断变化。 nn结论：最好在更广泛的政策变化背景下看待准则的制定和传播。指南实施研究应在数据之前和之后进行报告，并纳入重要的定性成分，以识别重要的背景因素。

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