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Abstract：
BACKGROUND: Delayed referral of patients with chronic limb-threatening ischaemia (CLTI) from the community to vascular services may increase risk of amputation due to delayed revascularisation. Lack of appropriate guidance for clinicians in the community may contribute to this problem. This documentary analysis investigated referral guidance available to primary care clinicians.
METHODS: National and international documents providing guidance on CLTI management were identified by searching sources including Medline, Embase, Guidelines International Network and College/Society websites. Data were extracted on referral recommendations, target audience and author groups. Recommendations were coded according to the Behaviour Change Technique Taxonomy. Clinical practice guideline quality and ease of implementation were assessed independently by two reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II and Guideline Implementability Appraisal (GLIA) tools, respectively.
RESULTS: 12 documents containing guidance on CLTI referrals were included. Five were clinical practice guidelines. Nine targeted clinicians in the community among their audience, yet only one included a primary care clinician in their author group. Recommendations on identification and referral of CLTI were often in non-specific language and frequently assumed specialist knowledge of vascular disease. Just 4 of the 93 behaviour change techniques were identified in the guidance documents. Three relevant domains of the AGREE II tool were scored for five clinical practice guidelines: stakeholder involvement (range 21.4%-52.4%, mean 42.9%), clarity of presentation (range 71.4%-92.9%, mean 82.9%) and applicability (25.0%-57.1%, mean 36.8%). The GLIA tool identified barriers to ease of implementation for all five clinical practice guidelines.
CONCLUSIONS: Most guidance for clinicians in the community on the management of CLTI has been written without their input and assumes knowledge of vascular disease, which may be lacking. Future guidance development should involve community clinicians, consider using additional behaviour change techniques, and improve the applicability and ease of implementation of recommendations.
METHODS: National and international documents providing guidance on CLTI management were identified by searching sources including Medline, Embase, Guidelines International Network and College/Society websites. Data were extracted on referral recommendations, target audience and author groups. Recommendations were coded according to the Behaviour Change Technique Taxonomy. Clinical practice guideline quality and ease of implementation were assessed independently by two reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II and Guideline Implementability Appraisal (GLIA) tools, respectively.
RESULTS: 12 documents containing guidance on CLTI referrals were included. Five were clinical practice guidelines. Nine targeted clinicians in the community among their audience, yet only one included a primary care clinician in their author group. Recommendations on identification and referral of CLTI were often in non-specific language and frequently assumed specialist knowledge of vascular disease. Just 4 of the 93 behaviour change techniques were identified in the guidance documents. Three relevant domains of the AGREE II tool were scored for five clinical practice guidelines: stakeholder involvement (range 21.4%-52.4%, mean 42.9%), clarity of presentation (range 71.4%-92.9%, mean 82.9%) and applicability (25.0%-57.1%, mean 36.8%). The GLIA tool identified barriers to ease of implementation for all five clinical practice guidelines.
CONCLUSIONS: Most guidance for clinicians in the community on the management of CLTI has been written without their input and assumes knowledge of vascular disease, which may be lacking. Future guidance development should involve community clinicians, consider using additional behaviour change techniques, and improve the applicability and ease of implementation of recommendations.
摘要：
背景：慢性威胁肢体缺血（CLTI）患者延迟从社区转诊到血管服务机构可能会增加由于延迟的血运重建导致的截肢风险。缺乏对社区临床医生的适当指导可能会导致此问题。此文献分析调查了可用于初级保健临床医生的转诊指导。
方法：通过搜索包括Medline在内的来源，确定了提供CLTI管理指导的国家和国际文件，Embase,准则国际网络和学院/社会网站。数据是根据转诊建议提取的，目标受众和作者群体。根据行为改变技术分类对建议进行编码。临床实践指南的质量和实施的难易程度由两名审稿人使用评估指南研究与评价（AGREE）II和指南可实施性评估（GLIA）工具独立评估。分别。
结果：包括12份包含CLTI转诊指南的文件。五项是临床实践指南。社区中有9名目标临床医生在他们的观众中，然而,只有一名作者组包括一名初级保健临床医生.关于CLTI的识别和转诊的建议通常使用非特异性语言，并且经常假定具有血管疾病的专业知识。在指导文件中只确定了93种行为改变技术中的4种。AGREEII工具的三个相关领域针对五个临床实践指南进行了评分：利益相关者参与（范围为21.4％-52.4％，平均42.9%)，表述清晰度(范围71.4%-92.9%，平均82.9%)和适用性(25.0%-57.1%，平均36.8%）。GLIA工具确定了所有五个临床实践指南易于实施的障碍。
结论：大多数社区临床医生关于CLTI管理的指南是在没有他们的投入的情况下编写的，并假定他们对血管疾病有了解，这可能是缺乏的。未来的指导发展应涉及社区临床医生，考虑使用额外的行为改变技术，并提高建议的适用性和实施便捷性。
方法：通过搜索包括Medline在内的来源，确定了提供CLTI管理指导的国家和国际文件，Embase,准则国际网络和学院/社会网站。数据是根据转诊建议提取的，目标受众和作者群体。根据行为改变技术分类对建议进行编码。临床实践指南的质量和实施的难易程度由两名审稿人使用评估指南研究与评价（AGREE）II和指南可实施性评估（GLIA）工具独立评估。分别。
结果：包括12份包含CLTI转诊指南的文件。五项是临床实践指南。社区中有9名目标临床医生在他们的观众中，然而,只有一名作者组包括一名初级保健临床医生.关于CLTI的识别和转诊的建议通常使用非特异性语言，并且经常假定具有血管疾病的专业知识。在指导文件中只确定了93种行为改变技术中的4种。AGREEII工具的三个相关领域针对五个临床实践指南进行了评分：利益相关者参与（范围为21.4％-52.4％，平均42.9%)，表述清晰度(范围71.4%-92.9%，平均82.9%)和适用性(25.0%-57.1%，平均36.8%）。GLIA工具确定了所有五个临床实践指南易于实施的障碍。
结论：大多数社区临床医生关于CLTI管理的指南是在没有他们的投入的情况下编写的，并假定他们对血管疾病有了解，这可能是缺乏的。未来的指导发展应涉及社区临床医生，考虑使用额外的行为改变技术，并提高建议的适用性和实施便捷性。
