Opinions of Japanese rheumatology physicians regarding clinical practice guidelines
Opinions of Japanese rheumatology physicians regarding clinical practice guidelines
复制标题
DOI：
10.1093/intqhc/mzp060
复制
发表时间：
2010-04-01
影响因子：
2.6
通讯作者：
Ochi, Takahiro
中科院分区：
文献类型：
--
作者：
Higashi, Takahiro;Nakayama, Takeo;Ochi, Takahiro
设计两次横断面问卷调查，第一次在新的循证RA临床实践指南发布前进行，第二次在实施后进行。在日本以流变学为中心的实践。随机抽取在日本风湿病基金会注册的符合注册标准的RA治疗经验的医生。2004年新指南发布后，指南使用者比例从48%上升到60%（P < 0.01）。大多数人同意临床实践指南支持实践中的决策，尽管在第二次调查中支持决策的比例略有下降，从83%下降到77%（P < 0.01），而对限制医生自主权的担忧从18%上升到22%（P = 0.01）。虽然只有39%的医生认为临床实践指南会导致医疗事故诉讼，但担心临床实践指南会被用于对提供者提起法律的诉讼的医生比例大于预期他们会为提供者辩护的医生比例（58 vs 30%，P <0. 001）。临床实践指南在日本风湿科医生中得到广泛接受，尽管在引入新指南后比例略有下降。其中一个原因可能是担心在医疗事故诉讼中使用该指南。为了便于实施，应密切监测医生对指南支持的趋势。
Design. Two cross-sectional questionnaire surveys, the first conducted before publication of new evidence-based RA clinical practice guidelines and the second conducted after implementation.Setting. Rheumatology-focused practices in Japan.Participants. A random sample of physicians registered with the Japan Rheumatism Foundation who satisfied the registration criteria with regard to experience with RA care.Results. The percentage of guideline users increased from 48 to 60% following publication of the new RA guidelines in 2004 (P < 0.01). The majority agreed that clinical practice guidelines support decision-making in practice, although the proportion of supportive responses decreased slightly in the second survey, from 83 to 77% (P < 0.01) for decision-making, while concern about restricting physician autonomy increased from 18 to 22% (P = 0.01). While only 39% of physicians felt that clinical practice guidelines would contribute to malpractice litigation, the proportion of physicians who were concerned that clinical practice guidelines would be used to bring legal action against providers was larger than that who expected they would defend providers (58 vs 30%, P < 0.001).Conclusions. Clinical practice guidelines are well accepted among Japanese rheumatology physicians, albeit that the proportion decreased slightly after the introduction of new guidelines. One reason for this may be concern about the use of the guidelines in malpractice litigation. To facilitate implementation, trends in physician support for the guidelines should be closely monitored.