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目的探讨在实践中评价临床实践指南开发质量的科学方法,对社区转诊指南的质量和临床效果进行科学评价。方法采用问卷调查法对北京市城区和远郊区各一个区内试用转诊指南的社区医生进行调查,就指南的质量和效果进行测评。采用“全面性、可理解性、严谨性、清晰性、适宜性、必要性、实施阻碍因素”等作为指南质量评价指标,采用“对专业知识的帮助、对减少误诊漏诊的帮助、对减少过度转诊的帮助”作为效果评价指标。采用百分率、2χ检验、秩和检验、回归分析等统计方法分析指南的质量和效果及影响指南效果的因素。结果共回收合格问卷160份,包括宣武区60份、顺义区100份。试用期间,社区医生对转诊指南进行了一定的使用。大多数社区医生对指南的质量和效果持肯定态度。在对专业知识的帮助方面,转诊指南对较低职称的社区医生帮助更大;在减少过度转诊方面,转诊指南对远郊区县的社区医生,从事专业年限较短的社区医生,乡村医生、医士、助理医师、无职称的社区医生取得了更明显的效果。指南全面性、适宜性指标与减少过度转诊指标存在定量关系。结论应重视社区临床指南的开发与试用评价。评价方法采用调查问卷的方式,采取质量和效果有关指标进行评价是可行的。为保证实施效果,今后开发社区指南时应该更加注意指南的全面性和适宜性。
Objective To explore the scientific method of evaluating the quality of developing clinical practice guidelines in practice and evaluate the quality and clinical effect of community referral guidelines. Methods A questionnaire survey was conducted to investigate the community doctor who tried out referral guidelines in one urban and suburban area of Beijing to evaluate the quality and effectiveness of the guidelines. Adopting “comprehensiveness, comprehensibility, rigor, clarity, suitability, necessity and obstacles to implementation” as the guideline of quality evaluation and adopting the help of professional knowledge to help reduce misdiagnosis and missed diagnosis, Help reduce excessive referral "as an indicator of effectiveness. The percentage, 2χ test, rank sum test, regression analysis and other statistical methods were used to analyze the quality and effect of the guideline and the factors that influence the effect of the guideline. Results A total of 160 qualified questionnaires were returned, including 60 in Xuanwu District and 100 in Shunyi District. During the probationary period, the community doctor made some use of referral guidelines. Most community doctors are positive about the quality and effectiveness of the guidelines. Referral guidelines are more helpful to lower-rated community doctors in terms of helping with professional knowledge; referral guidelines are available for community doctors in outlying counties, community doctors working for shorter years of practice, rural Doctors, doctors, assistant physicians and community doctors without titles have made even more pronouncements. The comprehensiveness of the guidelines, the suitability indicators and the reduction of over-referral indicators have a quantitative relationship. Conclusion The development and trial evaluation of community clinical guidelines should be emphasized. Evaluation methods using questionnaires, the quality and effectiveness of the relevant indicators for evaluation is feasible. In order to ensure the effectiveness of the implementation, we should pay more attention to the comprehensiveness and suitability of the guidelines in the future when developing community guidelines.