The relationship between introduction of American Society of Clinical Oncology guidelines and the use of colony-stimulating factors in clinical practice in a Paris university hospital
The relationship between introduction of American Society of Clinical Oncology guidelines and the use of colony-stimulating factors in clinical practice in a Paris university hospital
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DOI：
10.1016/s0149-2918(01)80095-3
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发表时间：
2001-07-01
影响因子：
3.2
通讯作者：
Becker, A
中科院分区：
文献类型：
--
作者：
Debrix, I;Tilleul, P;Becker, A
背景临床实践指南由专业医学协会或委员会定期发布，以帮助从业人员做出临床决策。然而，目前还不清楚这些指南是否对临床实践有任何持久的影响。目的：本研究的目的是评估美国临床肿瘤学会（ASCO）关于使用造血集落刺激因子（CSF）在巴黎大学医院癌症护理指南的影响。方法：这项研究于1996年和1997年在巴黎的一家拥有830张床位的大学医院Hopital Tenon进行，分别在ASCO指南实施之前和之后。该指南首先作为继续医学教育计划进行传播，然后使用总结该指南的CSF处方订单表积极实施。在患者咨询期间必须使用该表格，并将其发送至Hopital Tenon药房进行CSF分发。即使CSF的使用不符合ASCO指南，药房也会按照处方配药。巴黎的其他七所大学医院组成了对照组，这些医院没有积极实施ASCO指南。主要结果指标是符合1996年ASCO指南更新的处方比例。结果：在ASCO指南实施前，研究中心和对照中心CSF使用符合指南的比例分别为39%（41/105）和31%（16/51）（P > 0.05）。在指南传播和实施后6个月，研究组中符合ASCO指南的CSF处方比例与基线相比显著增加（P = 0.003），达到61%（50/82）。然而，即使在指南实施后，研究组对主要预防性CSF给药指南的依从性与实施前相比也没有显著变化（实施前12% [5/41] vs实施后6% [2/33]; P > 0.05）。结果表明，积极实施策略（继续医学教育和CSF处方提醒表）和医生遵守ASCO指南之间存在关联。ASCO指南的实施似乎对医疗实践产生了一些影响。
Background. Clinical practice guidelines are issued periodically by professional medical societies or committees to assist practitioners in clinical decision making. However, it is unclear whether such guidelines have any lasting impact on clinical practice.Objective: The purpose of this study was to assess the impact of the American Society of Clinical Oncology (ASCO) guidelines regarding use of hematopoietic colony-stimulating, factors (CSF) on cancer care in a university hospital in Paris.Methods: The study was performed at Hopital Tenon, an 830-bed university hospital in Paris, in 1996 and 1997, both before and after the ASCO guidelines were implemented. The guidelines were first disseminated as a continuing medical education program and then actively implemented using a CSF prescription order form summarizing the guidelines. This form had to be used during the patient consultation and was sent to the Hopital Tenon pharmacy for CSF dispensation. Even if CSF use did not comply with the ASCO guidelines, the pharmacy filled the prescription. Seven other university hospitals in Paris, where the ASCO guidelines were not actively implemented, comprised the control group. The main outcome measure was the proportion of prescriptions in compliance with the 1996 update of the ASCO guidelines. Secondary outcome measures were the proportions of prescriptions in compliance with ASCO guidelines regarding primary prophylactic, secondary prophylactic, and therapeutic CSF administration.Results: Before implementation of the ASCO guidelines, CSF use in compliance with the guidelines was 39% (41/105) at the study site and 31% (16/51) at the control sites (P > 0.05). Six months after dissemination and implementation of the guidelines, the proportion of CSF prescriptions complying with ASCO guidelines increased significantly versus baseline (P = 0.003) in the study group, to 61% (50/82). However, even after the Guidelines were implemented, compliance with guidelines on primary prophylactic CSF administration did not change significantly versus before implementation in the study group (12% [5/41] before implementation vs 6% [2/33] after implementation; P > 0.05).Conclusions: The results suggest an association between the active implementation strategy (continuing medical education and CSF prescription reminder form) and physician compliance with the ASCO guidelines. Implementation of the ASCO guidelines appears to have had some impact on medical practice.