临床实践指南(CPG)将证据基础分解为建议。CPG依从性与更好的患者预后相关。然而,准备和传播CPGs是一项涉及多名技术人员的昂贵任务。此外,仅靠传播并不能确保CPG的遵守。不坚持的原因通常很复杂,但了解实践差异和不依从的原因是提高CPG依从性和协调临床上适当且具有成本效益的护理的关键.
概述提高指南依从性的方法,提供泌尿科特定的知识-实践差距的例子,并强调由实施科学提供的潜在解决方案。
实施科学的三种常见方法(知识到行动框架,实施研究综合框架,和行为变化轮),是总结的。
说明了泌尿外科的三个实施问题:在非肌肉浸润性膀胱癌中,单次灌注膀胱内化疗的使用不足,在局部前列腺癌中过度使用雄激素剥夺治疗,和指南不一致的前列腺癌成像。讨论了使用实施科学方法解决这些实施问题的研究。
泌尿科医师,病人,卫生保健提供者,资助者,和其他关键利益相关者必须承诺可靠地捕获和报告患者结果数据,实践变化,指导方针坚持,以及坚持对结果的影响。利用实施科学框架是提高指南依从性和循证护理相关益处的良好下一步。
临床实践指南文件由专家小组创建。这些文件概述了患者护理中使用的测试和治疗的证据。他们还提供建议,预计在大多数情况下,临床医生将遵循这些建议。有时候,卫生保健专业人员不能或不遵循这些建议,并不总是清楚为什么。在这篇综述文章中,我们将介绍一些解决此不依从性问题的研究方法的示例,并提供一些针对泌尿外科的示例。
Clinical practice guidelines (CPGs) distil an evidence base into recommendations. CPG adherence is associated with better patient outcomes. However, preparation and dissemination of CPGs are a costly task involving multiple skilled personnel. Furthermore, dissemination alone does not ensure CPG adherence. Reasons for nonadherence are often complex, but understanding practice variations and reasons for nonadherence is key to improving CPG adherence and harmonising clinically appropriate and cost-effective care.
To overview approaches to improving guideline adherence, to provide urology-specific examples of knowledge-practice gaps, and to highlight potential solutions informed by implementation science.
Three common approaches to implementation science (the Knowledge-To-Action framework, the Consolidated Framework for Implementation Research, and the Behaviour Change Wheel), are summarised.
Three implementation problems in urology are illustrated: underuse of single instillation of intravesical chemotherapy in non-muscle-invasive bladder cancer, overuse of androgen deprivation therapy in localised prostate cancer, and guideline-discordant imaging in prostate cancer. Research using implementation science approaches to address these implementation problems is discussed.
Urologists, patients, health care providers, funders, and other key stakeholders must commit to reliably capturing and reporting data on patient outcomes, practice variations, guideline adherence, and the impact of adherence on outcomes. Leverage of implementation science frameworks is a sound next step towards improving guideline adherence and the associated benefits of evidence-based care.
Clinical practice guideline documents are created by expert panels. These documents provide overviews of the evidence for the tests and treatments used in patient care. They also provide recommendations and it is expected that in most circumstances clinicians will follow these recommendations. Sometimes, health care professionals cannot or do not follow these recommendations and it is not always clear why. In this review article we look at some examples of research approaches to addressing this problem of nonadherence and we provide some examples specific to urology.