Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
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DOI：
10.1136/bmj.317.7162.858
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发表时间：
1998-09-26
影响因子：
--
通讯作者：
Mokkink, H
中科院分区：
文献类型：
--
作者：
Grol, R;Dalhuijsen, J;Mokkink, H
目的：为了确定临床实践指南的哪些属性影响指南在临床实践决策中的使用。设计：观察性研究，涉及使用47种不同的建议，从10个国家的临床指南12个不同的属性的临床指南，例如，基于证据的，有争议的，具体的。设置：在荷兰的一般做法。主题：结果：61名全科医生在与患者接触中所做的12 880项决策中，平均有61%（7915/12 880）的决策遵循了指南的建议。35%（886/2497）的决策遵循有争议的建议，68%（7029/10383）的决策遵循无争议的建议。36%（826/2280）的决定遵循了模糊和不具体的建议，67%（7089/10600）的决定遵循了明确的建议。44%（1 278/29 12）的决定遵循了要求改变现有惯例的建议，67%（6637/9968）的决定没有遵循这些建议。基于证据的建议被用于实践的建议，而不是基于研究证据（71%（2745/3841）v 57%（5170/9039））。结论：人和组织设置基于证据的临床实践指南应考虑到一些其他重要属性的有效建议，临床实践。
Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete.Setting: General practice in the Netherlands.Subjects: 61 general practitioners who made 12 880 decisions in their contacts with patients.Main outcome measures: Compliance of decisions with clinical guidelines according to the attribute of the guideline.Results: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1 278/29 12) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)).Conclusions: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.