Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice.
Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice.
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DOI：
10.9778/cmajo.20130040
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发表时间：
2014-01-01
期刊：
影响因子：
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通讯作者：
Grunfeld, Eva
中科院分区：
文献类型：
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作者：
Campbell-Scherer, Denise;Rogers, Jess;Grunfeld, Eva
背景：基于现有工具改善家庭实践中的慢性病预防和筛查 (BETTER) 随机对照试验的目的是改善多种疾病（糖尿病、心血管疾病、癌症）和一些相关生活方式因素（吸烟、酗酒、营养不良、缺乏身体活动）的一级预防和筛查。在本文中，我们描述了如何协调基于证据的临床实践指南建议和患者工具来确定 BETTER 试验的内容。方法：我们通过结构化文献检索确定了临床实践指南和工具；我们纳入了索引文献和灰色文献。从这些指南中提取建议并将其整合到知识产品和结果测量中，以便在 BETTER 试验中使用。最终用户（家庭医生、执业护士、护士和营养师）参与审查建议和工具，并根据 BETTER 试验和家庭实践的需要定制内容。 结果：总共为每种情况确定了 3-5 个高质量指南；从这些中，我们确定了预防和筛查慢性病的高级建议。指南建议受到相互冲突的建议、模糊的措辞和不同的建议强度分类法的限制。缺乏高质量的证据来证明可以采取哪些措施来提高抑郁症患者对指南的接受程度。我们为实施计划开发了更好的临床算法。虽然很难确定高质量的工具，但还是确定了 180 个感兴趣的工具。解释：BETTER 试验的干预措施是通过整合现有指南和工具，并在整个过程中与最终用户合作来提高干预措施的实践效用而建立的。试验注册：ISRCTN07170460。
BACKGROUND: The aim of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) randomized controlled trial is to improve the primary prevention of and screening for multiple conditions (diabetes, cardiovascular disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical practice guideline recommendations and patient tools to determine the content for the BETTER trial.METHODS: We identified clinical practice guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family practice.RESULTS: In total, 3-5high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to improve the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180tools of interest were identified.INTERPRETATION: The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention's utility for practice.TRIAL REGISTRATION: ISRCTN07170460.