背景:作为现成证据的来源,由专家临床医生和方法学家严格综合和解释,临床指南是基于证据的实践工具包的一部分,which,转化为实践建议,有可能改善护理过程和患者预后。在巴西,巴西统一卫生系统临床指南的开发和更新过程(Sistema乌尼科德,SUS)已经被卫生部很好地系统化。然而,这些准则的实施过程尚未得到讨论和结构良好。因此,本项目的第一步和本研究的主要目的是总结用于促进临床实践指南实施和传播的策略有效性的证据.
方法:本综述使用系统评价方法来定位和评估已发表的有关临床实践指南实施策略的系统评价,并遵守PRISMA系统评价指南(PRISMA)。
结果:本概述确定了36项系统评价,涉及针对医疗机构的30项策略,医疗保健提供者和患者促进指南实施。报道最多的干预措施是教育材料,教育会议,提醒,学术细节、审计和反馈。护理路径-单一干预,教育会议-单一干预,组织文化,以及审计和反馈——这两种策略都与其他策略结合实施——是从系统评价中被归类为普遍有效的策略。在荟萃分析中,当单独使用时,组织文化,教育干预和提醒被证明是有效的促进医生坚持指南。当与其他策略结合使用时,组织文化也被证明是有效的。对于与患者相关的结果,教育干预在短期和长期中均显示出有效的疾病目标结果。
结论:本综述提供了指南实施的最佳证据的广泛总结。即使收录的文献突出了与缺乏标准化相关的各种限制,研究的方法学质量,尤其是缺乏关于一种战略优于另一种战略的结论,本研究提供的结果摘要提供了有关过去几年中研究最广泛的策略及其在应用中的有效性的信息.因此,这个全景可以支持适合SUS和其他卫生系统的战略决策,寻求对准则的适当使用产生积极影响,医疗保健结果和SUS的可持续性。
BACKGROUND: As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice
guideline implementation and dissemination.
METHODS: This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice
guideline implementation and adhered to the PRISMA
guidelines for systematic review (PRISMA).
RESULTS: This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote
guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways-single intervention, educational meeting-single intervention, organizational culture, and audit and feedback-both strategies implemented in combination with others-were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians\' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
CONCLUSIONS: This overview provides a broad summary of the best evidence on
guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.