The role of clinical practice guidelines in enhancing quality and reducing racial/ethnic disparities in paediatrics.
The role of clinical practice guidelines in enhancing quality and reducing racial/ethnic disparities in paediatrics.
复制标题
临床实践指南在提高儿科质量和减少种族/民族差异方面的作用。
DOI：
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发表时间：
2002
影响因子：
5.8
通讯作者：
G. Flores
中科院分区：
文献类型：
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作者：
M. Cabana;G. Flores
儿科医生认为，临床实践指南（CPG）可以改善病人的护理，但只有当CPG是灵活的，严格的测试，有效的，而不是惩罚性的使用，并希望提高质量，而不是降低成本的动机。儿科医生可能会避免使用CPG，因为很少有人经过严格的评估，以证明提高质量和降低成本。有效的医生遵守CPG可以被视为一个多步骤的过程，每一步都有潜在的障碍。遵守的障碍可以分为内部（缺乏认识，熟悉，协议，自我效能，对给定的CPG的结果预期和无法克服当前实践的惯性）或外部（所需的CPG实施基础设施的缺陷）。克服CPG依从性障碍的有效干预措施可以包括向从业者传播CPG信息、继续医学教育、向医生反馈以及为CPG实施建立坚实的基础设施的多种模式。遵循循证哮喘CPG可能是减少或消除哮喘治疗中种族/民族差异的潜在有力工具，因为CPG包括基于症状的严格、明确的方案，而不是种族、民族或社会经济地位。
Paediatricians believe that clinical practice guidelines (CPGs) can improve patient care but only when the CPGs are flexible, rigorously tested, effective, not used punitively and are motivated by desires to improve quality, not reduce costs. Paediatricians may avoid using CPGs because few have been subjected to rigorous evaluation to demonstrate improved quality and reduced costs. Effective physician adherence to a CPG can be viewed as a multi-step process with potential barriers at each step. Barriers to adherence can be classified as internal (lack of awareness, familiarity, agreement, self-efficacy, outcome expectancy regarding a given CPG and inability to overcome the inertia of current practice) or external (deficits in the required CPG implementation infrastructure). Effective interventions for overcoming barriers to CPG adherence can include multiple modes of disseminating CPG information to practitioners, continuing medical education, feedback to physicians and establishing a solid infrastructure for CPG implementation. Adherence to evidence-based asthma CPGs may be a potentially powerful tool for reducing or eliminating racial/ethnic disparities in asthma treatment because CPGs consist of strict, explicit protocols based on symptoms, not race, ethnicity or socioeconomic status.