Practice guidelines: a new reality in medicine. III. Impact on patient care.
Practice guidelines: a new reality in medicine. III. Impact on patient care.
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实践指南：医学的新现实。
作者：
S. Woolf
实践指南正在整个医学领域引入，但对其对患者护理影响的预期取决于一个人是临床医生，患者，付款人，管理者还是政治家。支持者希望指南将提高从业者的知识，态度和行为，并优化健康结果，成本和医疗事故决策，但这些影响的科学证据是有限的。也有人担心，指导方针可能会损害病人的护理。临床医生担心指南将促进“食谱医学”，减少他们的自主权和收入，并增加法医责任。一个特别令人关切的问题涉及到执法方案的扩大，这些方案要求临床医生遵守准则，否则将面临经济或其他处罚。由于科学性差、分析过程不完善以及患者的差异，指南很少能确定地定义最佳护理。建议的措辞往往非常具体，以牺牲科学有效性为代价来实现清晰度。严格执行这些指南可能会伤害患者，干扰个性化护理，增加成本，并促进对有充分理由偏离这些指南的临床医生的不公平判断。提出了一个模型，执行强度的科学和临床质量的指南。
Practice guidelines are being introduced throughout medicine, but expectations about their impact on patient care depend on whether one is a clinician, patient, payer, administrator, or politician. Proponents hope that guidelines will enhance the knowledge, attitudes, and behavior of practitioners and will optimize health outcomes, costs, and malpractice decisions, but scientific evidence of these effects is limited. There are also concerns that guidelines could harm patient care. Clinicians worry that guidelines will promote "cookbook medicine," decrease their autonomy and income, and increase medicolegal liability. A particular concern relates to the expansion of enforcement programs that require clinicians to follow guidelines or face financial or other penalties. Guidelines can rarely define optimal care with certainty, due to poor science, imperfect analytic processes, and differences in patients. Recommendations are often worded in highly specific language that achieves clarity at the expense of scientific validity. Rigid enforcement of such guidelines could harm patients, interfere with the individualization of care, increase costs, and promote unfair judgments against clinicians who deviate from them for good reasons. A model that links the intensity of enforcement to the scientific and clinical quality of guidelines is proposed.
筛查乳房X光检查：错失临床机会？
DOI：
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发表时间：
1990
期刊：
JAMA
影响因子：
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作者：
通讯作者：
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