Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson's disease. A National Survey of German neurologists in private practice
Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson's disease. A National Survey of German neurologists in private practice
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DOI：
10.1007/s00415-009-5178-3
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发表时间：
2009-10-01
影响因子：
6
通讯作者：
Eggert, Karla
中科院分区：
文献类型：
--
作者：
Larisch, Astrid;Oertel, Wolfgang H.;Eggert, Karla
尽管临床实践指南（CPG）的发展取得了很大进展，但这些指南的传播和实施策略很少。本研究探讨了神经科医生对CPG的态度和实施CPG的障碍，特别关注帕金森病CPG（PD-CPG）。在2007年进行了一项横断面调查，在德国私人执业的213名神经科医生的代表性样本。主要的结果措施是突尼斯态度量表和障碍评估的CPGs。此外，还评估了PD-CPG的认识、适用性和有用性。大多数神经科医生同意CPG旨在提高护理质量（82.2%; n = 171），是良好的教育工具（59.4%; n = 120），是专家意见的无偏见综合（58.9%; n = 119）。指南实施的主要障碍是缺乏时间（39.3%; n = 81），无法协调患者的偏好与指南建议（34.3%; n = 71），以及缺乏意识（32.5%; n = 67）。共有187名（88.2%）神经科医生知道PD-CPG，其中163名（92.6%）认为它“有益”，173名（94.6%）在日常实践中应用它。然而，只有51（28.8%）的神经科医生认为，该指南导致护理质量的改善。然而，63（32%）赞成为患者制定特殊指南。定性资料分析显示，PD-CPG的积极方面多于消极方面;积极的评价包括“治疗促进”，“阶梯式治疗方案”和“提高自我效能”。批评意见主要涉及与日常实践缺乏相关性以及准则过于僵化。私人执业的神经科医生对指南普遍持积极态度。PD-CPG是众所周知的，经常使用，但其对护理质量的影响被认为是有限的。因此，需要进一步的研究来解决未来版本的PD-CPG中的日常实践问题，并调查在医生和患者层面实施的影响。
Although much progress has been made in the development of clinical practice guidelines (CPGs), there are few strategies for dissemination and implementation of these guidelines. This study examines the attitudes of neurologists to CPGs and barriers to CPG implementation, with a particular focus on the Parkinson's disease CPG (PD-CPG). A cross-sectional survey was performed in 2007 with a representative sample of 213 neurologists in private practice in Germany. The main outcome measures were the Tunis Attitudinal Scale and barrier assessment of CPGs. In addition, the awareness, applicability, and usefulness of the PD-CPG were assessed. Most of the neurologists agreed that CPGs are intended to improve the quality of care (82.2%; n = 171), are good educational tools (59.4%; n = 120), and are an unbiased synthesis of expert opinion (58.9%; n = 119). The main barriers to guideline implementation were lack of time (39.3%; n = 81), inability to reconcile patient preferences with guideline recommendations (34.3%; n = 71), and lack of awareness (32.5%; n = 67). A total of 187 (88.2%) of the neurologists were aware of the PD-CPG, of whom 163 (92.6%) found it "beneficial" and 173 (94.6%) applied it in daily practice. Nevertheless, only 51 (28.8%) of neurologists considered that the guidelines led to an improvement in the quality of care. However, 63 (32%) favored a special guideline for patients. Qualitative data analysis revealed more positive than negative aspects of the PD-CPG; positive comments included "treatment facilitation", "a stepped therapy schema" and "increasing self-efficacy". Criticism mostly concerned the lack of relevance to everyday practice and the rigidity of the guidelines. Neurologists in private practice have a generally positive attitude to guidelines. The PD-CPG is well-known and often used, but its impact on quality of care is considered to be only modest. Thus, further research is needed to address issues of daily practice in future versions of the PD-CPG and to investigate the effects of implementation at the physician and patient levels.