Page 7 - 2023-01-中国全科医学

·2· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn January 2023, Vol.26 No.1

of high-quality and effective general practice services. Research on the development，application and effectiveness evaluation
of guidelines in general practice is insufficient. Objective To understand the development and application of international
guidelines in general practice，informing the development and utilization of relevant guidelines in China. Methods The
PubMed database was systematically searched from August to September 2022 for studies in English related to the development，
application and effectiveness of guidelines in general practice published during January 1，2012 to September 7，2022. The
author information and focused issues as well as publication journals of the studies were extracted. And associated factors
of the development，distribution and use，and effectiveness of guidelines were reviewed. Results （1）A number of
countries，including China，conducted the research using quantitative，qualitative，literature review and theoretical methods.
（2）Organisations of general practitioners（GPs） and researchers in general practice leading or participating in guideline
development，can improve the guideline acceptability and applicability，and the integration of physician experiences and patient
preferences in shaping the guideline. General practice consensus is an appropriate type of the guideline. Referral recommendation
is one key component of the guidelines. Guideline analysis and adaptation can be used as a strategy for GPs training.
（3）Compared with specialty guidelines，the application of guidelines in general practice has been affected by more factors.
Problem-oriented and self-guided guideline trainings are beneficial to the improvement of guideline compliance. Clinical audits
and evidence-based medicine journal clubs are common and effective approaches for promoting guideline implementation. GPs'
feedback on the guideline contributes to continuous improvement of the guidelines. （4）The impact of these guidelines on GPs'
practice behaviour can be assessed observationally，while that on patient outcomes requires to be assessed using more rigorous
and complex study designs. Conclusion GPs' participation in the development，implementation and evaluation of the guidelines
is an enviable trend of the development in evidence-based general practice. GPs' experience and humanism，patients' preferences
and expectations，and various internal and external factors associated with general practice，all need to be incorporated into the
development，implementation，and evaluation of the guidelines，under collaboration with methodological experts.
【Key words】 General practice；Evidence-based medicine；Diagnostic and treatment guideline；Guideline
development；Guideline implementation；Guideline evaluation；Two-way referral；Research design；Review

截至本文初稿完成时（2022-09-07），中国学术 促成和阻碍指南 / 共识实施的因素有哪些？怎样开发
期刊已发表循证医学相关文章万篇有余，显示出了 和实施指南 / 共识才能使之在全科医学服务中得到预
中国 20 多年来在循证医学领域的活跃学术氛围。《中 期利用？这是本研究关心的问题。本研究通过检索、
国全科医学》杂志第 1 次发表循证医学相关文章是 分析相关文献，旨在了解全科医生对全科医学相关
在 1999 年 ［1-2］ ，至今发表主题为“指南”的文章已 指南的认知、态度和看法，探索全科医生们应如何
达 520 篇，多为针对全科医学相关指南的介绍与解读。 参与指南 / 共识的开发，如何在临床实践中使用循证
全科医学是“既要科学，又要温度”的临床服务 ［3］ ， 医学，以及使用临床指南会产生怎样的效果。希望
基于循证开展全科医学服务是必然的。随着基本医 本研究可以提高中国全科医学中循证服务指南的开
疗 / 全科医学服务在国家卫生健康系统中受重视程度 发和应用。同时，本研究也提出了在该领域需要进
的不断提高，与全科医学有关的实践指南、专家共 一步回答的研究问题，可供全科医学领域研究者和
识、立场声明等层出不穷，专业组织和卫生行政部 广大全科医生参考。
门以发布此类文件作为服务和费用管理的重要措施。 1 资料与方法
不过，指南 / 共识在全科医学服务中的被采纳和遵从 1.1 文献检索策略 于 2022 年 8—9 月，系统
情况，通常低于开发者的预期。很多全科医生赞同 检索 PubMed 数据库，以获取与全科相关指南
指南的重要性，也知道获取指南的途径，但在临床 开发、实施及应用相关的文献。检索词包括：
实践中却不一定采用指南的建议。这种对指南的知、 “guidelines、evidence-based practice、evidence
信、 行（knowledge，attitude/belief，practice，KAP） based medicine”“general practice、primary care、
脱离现象，说明循证医学的实践过程存在应用条件， general practitioner、family practitioner、family doctor、
或者存在阻碍因素 ［4］ 。作为指南 / 共识的终端使用 family physician”“perception、perceived、opinion、
者，全科医生的想法、态度和作为对循证医学实践至 attitude”“adherence、compliance”。文献纳入标准
关重要。全科医生对指南 / 共识的态度和看法如何？ 为：（1）具备研究文献的基本要素，包括立题依据、