Abstract：
BACKGROUND: Clinical practice guidelines (CPGs) improve patient care by standardising medical practice. However, little is known about their applicability in low-resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice.
OBJECTIVE: We describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low-resource setting in the Pacific.
METHODS: A mixed-methods design included a survey and focus groups. All 178 doctors in five departments at Fiji\'s largest tertiary hospital were invited to participate. Subsequently, two focus group interviews explored clinicians\' perspectives in more detail. Analysis included data description, multi-variable logistic, multinomial regression and manifest content analyses.
RESULTS: The response rate was 74%. Most doctors agreed that CPGs were good for patient management (100%), doctors continuing medical education (CME) (96%), patient education (73%), supported by systematic reviews (91%) and consistent with existing norms/values (83%). Ninety-five per cent stated that CPGs increased the quality of care, and 80% stated that CPGs increased physician satisfaction. Approximately two-thirds stated that CPGs decreased medical-legal problems (63%) and malpractice suits (68%). Sixty to 90% of doctors disagreed that CPGs were oversimplified/cookbook medicine (60%), too rigid to apply individually (65%), challenged physician autonomy (60%) or were ambiguous/unclear (86%) or not practical (89%). The preferred method of dissemination was CME, and quick reference guides were best for implementation. No formal CPG monitoring existed in any department.
CONCLUSIONS: Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary.
OBJECTIVE: We describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low-resource setting in the Pacific.
METHODS: A mixed-methods design included a survey and focus groups. All 178 doctors in five departments at Fiji\'s largest tertiary hospital were invited to participate. Subsequently, two focus group interviews explored clinicians\' perspectives in more detail. Analysis included data description, multi-variable logistic, multinomial regression and manifest content analyses.
RESULTS: The response rate was 74%. Most doctors agreed that CPGs were good for patient management (100%), doctors continuing medical education (CME) (96%), patient education (73%), supported by systematic reviews (91%) and consistent with existing norms/values (83%). Ninety-five per cent stated that CPGs increased the quality of care, and 80% stated that CPGs increased physician satisfaction. Approximately two-thirds stated that CPGs decreased medical-legal problems (63%) and malpractice suits (68%). Sixty to 90% of doctors disagreed that CPGs were oversimplified/cookbook medicine (60%), too rigid to apply individually (65%), challenged physician autonomy (60%) or were ambiguous/unclear (86%) or not practical (89%). The preferred method of dissemination was CME, and quick reference guides were best for implementation. No formal CPG monitoring existed in any department.
CONCLUSIONS: Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary.
摘要：
背景：临床实践指南（CPG）通过标准化医疗实践来改善患者护理。然而,对它们在低资源环境中的适用性知之甚少。自2010年以来，斐济引入了准则，以增加循证实践的应用。
目的：我们描述了传播，斐济指南实施的效用和监测，太平洋的低资源环境。
方法：混合方法设计包括调查和焦点小组。斐济最大的三级医院五个科室的所有178名医生均应邀参加。随后，两个焦点小组访谈更详细地探讨了临床医生的观点。分析包括数据描述，多变量Logistic，多项回归和清单内容分析。
结果：有效率为74%。大多数医生都认为CPG对患者管理有好处（100％），医生继续医学教育(CME)(96%)，患者教育（73%），得到系统评价(91%)的支持，并与现有规范/价值观(83%)一致。百分之九十五的人表示，CPG提高了护理质量，80%的人表示CPG提高了医生的满意度。大约三分之二的人表示，CPG减少了医疗法律问题（63％）和医疗事故诉讼（68％）。60％至90％的医生不同意CPG过于简化/食谱医学（60％），过于僵硬，无法单独应用(65%)，挑战医师自主性(60%)或模棱两可/不清楚(86%)或不切实际(89%).首选的传播方法是CME，和快速参考指南是最好的实施。任何部门都没有正式的CPG监测。
结论：大多数医生发现CPGs对于提高护理的一致性是有价值的。在低资源设置中，指南的传播应与CME配对，以提高其吸收。增加对指南使用的监测似乎是必要的。
目的：我们描述了传播，斐济指南实施的效用和监测，太平洋的低资源环境。
方法：混合方法设计包括调查和焦点小组。斐济最大的三级医院五个科室的所有178名医生均应邀参加。随后，两个焦点小组访谈更详细地探讨了临床医生的观点。分析包括数据描述，多变量Logistic，多项回归和清单内容分析。
结果：有效率为74%。大多数医生都认为CPG对患者管理有好处（100％），医生继续医学教育(CME)(96%)，患者教育（73%），得到系统评价(91%)的支持，并与现有规范/价值观(83%)一致。百分之九十五的人表示，CPG提高了护理质量，80%的人表示CPG提高了医生的满意度。大约三分之二的人表示，CPG减少了医疗法律问题（63％）和医疗事故诉讼（68％）。60％至90％的医生不同意CPG过于简化/食谱医学（60％），过于僵硬，无法单独应用(65%)，挑战医师自主性(60%)或模棱两可/不清楚(86%)或不切实际(89%).首选的传播方法是CME，和快速参考指南是最好的实施。任何部门都没有正式的CPG监测。
结论：大多数医生发现CPGs对于提高护理的一致性是有价值的。在低资源设置中，指南的传播应与CME配对，以提高其吸收。增加对指南使用的监测似乎是必要的。
