Abstract：
Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by \"a guideline\" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries.
This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, \"thematic reviews,\" which aggregate and enumerate the \"barriers and facilitators\" to guideline implementation. It then outlines a \"realist synthesis,\" focussing on testing the \"programme theories\" that practitioners have devised to improve guideline uptake.
Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change.
Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, \"thematic reviews,\" which aggregate and enumerate the \"barriers and facilitators\" to guideline implementation. It then outlines a \"realist synthesis,\" focussing on testing the \"programme theories\" that practitioners have devised to improve guideline uptake.
Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change.
Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
摘要：
不管健康问题，卫生部门,患者状况,或治疗方式，条款很有可能得到“准则”的支持，该准则提出了专业认可的最佳实践建议。在这种背景下,寻求评估如何有效遵循此类指导的研究激增。这些调查描绘了一幅令人沮丧的画面，并有许多指导方针提示嘴唇服务，注意力不集中,甚至是反对派。这种困境促使人们进一步研究如何改进指南的吸收，本文考虑了如何从这些询问中吸取教训。
这种巨大的材料对研究合成提出了相当大的挑战，这篇论文产生了一个关键的，两种试图满足这一任务的综述的方法学比较。首先,它概述了当前的正统观念，即,“主题评论，“汇总并列举了指南实施的障碍和促进者”。然后概述了一个“现实主义综合”，专注于测试从业者为提高指南吸收而设计的“程序理论”。
主题审查旨在提供一个明确的，促进者的综合目录和指南实施的障碍。因此，他们提出了对潜在问题的重述，而不是改进策略。现实主义者的方法假定，随着不同的利益相关者争夺责任，将任何准则纳入当前实践将产生意想不到的系统压力。这些扭曲将促使对准则进行补充修订，这反过来又会产生更多的菌株。现实主义评论遵循这种对组织变革的动态理解。
卫生保健决策者在充斥着指导方针的系统中运作。但是准则只有纸质权威。经理们不需要他们的利弊清单，因为准则的命运取决于他们的接受而不是他们的生产。他们确实需要有关如何设计和重新设计指南的决策支持，以便与不断发展的医疗保健提供系统相吻合。
这种巨大的材料对研究合成提出了相当大的挑战，这篇论文产生了一个关键的，两种试图满足这一任务的综述的方法学比较。首先,它概述了当前的正统观念，即,“主题评论，“汇总并列举了指南实施的障碍和促进者”。然后概述了一个“现实主义综合”，专注于测试从业者为提高指南吸收而设计的“程序理论”。
主题审查旨在提供一个明确的，促进者的综合目录和指南实施的障碍。因此，他们提出了对潜在问题的重述，而不是改进策略。现实主义者的方法假定，随着不同的利益相关者争夺责任，将任何准则纳入当前实践将产生意想不到的系统压力。这些扭曲将促使对准则进行补充修订，这反过来又会产生更多的菌株。现实主义评论遵循这种对组织变革的动态理解。
卫生保健决策者在充斥着指导方针的系统中运作。但是准则只有纸质权威。经理们不需要他们的利弊清单，因为准则的命运取决于他们的接受而不是他们的生产。他们确实需要有关如何设计和重新设计指南的决策支持，以便与不断发展的医疗保健提供系统相吻合。
