2016年欧洲胃肠病学联合慢性胰腺炎诊断和治疗指南(HaPanEU)为慢性胰腺炎的管理提供了循证建议,并通过评估指南依从性,对疾病管理的多个领域的护理质量进行了客观评估。因此,本研究的目的是使用HaPanEU指南作为参考标准,评估荷兰慢性胰腺炎患者目前的治疗水平和种类.这些患者中的大多数是在这些指南发布之前被诊断出来的。因此,在大多数患者中,关于慢性胰腺炎诊断过程的建议,本研究的结果代表了指南一致性,而非依从性.
一项回顾性横断面观察性队列研究纳入了荷兰全国慢性胰腺炎登记(CARE)患者亚组。共有39项关于慢性胰腺炎的非侵入性管理的建议被指定为质量指标(QI)。每位患者,我们确定了相关QI的数量,并评估了指南依从性.分析数据以确定与指南依从性相关的因素。
总的来说,纳入来自11家医院的97例慢性胰腺炎患者。每位患者,平均适用26个相关QI,平均依从率为53%。在45%的患者中,指南依从性低于50%。大多数未达到最佳管理的QIs与慢性胰腺炎并发症的管理有关。指南依从性与医院类型无关,性别,年龄或胰腺炎的病因。
在荷兰,对于所有非侵入性领域,对HaPanEU慢性胰腺炎管理建议的依从性为中等至低,这可能表明对这些患者的护理欠佳。更严格的指南依从性可以提高这些患者的护理水平和临床结局。需要在全国范围内采取方法,以提高临床医生和患者对关键指南建议的认识。
The 2016, United European Gastroenterology evidence-based
guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU) provided evidence-based recommendations for the management of chronic pancreatitis and allowed for the objective evaluation of the quality of care in several domains of disease management through assessment of guideline adherence. Therefore, the aim of this study is to evaluate the current level and the variety of care for chronic pancreatitis patients in the Netherlands using the HaPanEU
guidelines as a reference standard. The majority of these patients were diagnosed before the publication of these
guidelines. Therefore, in most patients, the results of the present study with respect to those recommendations regarding the diagnostic process of chronic pancreatitis represent guideline correspondence and not adherence.
A subgroup of patients from the Dutch nationwide chronic pancreatitis registry (CARE) was included in a retrospective cross-sectional observational cohort study. A total of 39 recommendations concerning the non-invasive management of chronic pancreatitis were appointed as quality indicators (QIs). Per patient, the number of relevant QIs was determined and guideline adherence was assessed. Data were analyzed to identify factors associated with
guideline adherence.
Overall, 97 patients with chronic pancreatitis from 11 hospitals were included. Per patient, a mean number of 26 relevant QIs was applicable, with an average adherence rate of 53%. In 45% of the patients,
guideline adherence was less than 50%. The majority of suboptimal managed QIs concerned the management of chronic pancreatitis complications. Guideline adherence was not associated with hospital type, sex, age or etiology of pancreatitis.
In the Netherlands, adherence to the HaPanEU recommendations for the management of chronic pancreatitis is moderate to low for all non-invasive domains, which may indicate suboptimal care for these patients. Closer guideline adherence could improve the level of care and the clinical outcomes of these patients. A nationwide approach to increase awareness of the key guideline recommendations among clinicians and patients is needed.